MR化学位移成像脑代谢物改变与肝硬化的临床相关性  

The clinical correlation between MR chemical shift imaging of cerebral metabolic changes and liver cirrhosis

作　　者：乔秀丽[1] 李振芝[2] 刘芹[1] 高孝忠[1] 王晓丰[1] 岳进勇 梁和业[1] 

机构地区：[1]山东威海市立医院消化内科,威海264200 [2]山东威海市立医院磁共振室,威海264200

出　　处：《中国肝脏病杂志（电子版）》2009年第1期1-6,共6页Chinese Journal of Liver Diseases：Electronic Version

摘　　要：目的利用MRS评价肝硬化患者脑代谢物的异常变化及其与Child-Pugh分级、肝功指标的相关性。方法应用3.0T磁共振对52例乙型肝炎肝硬化患者(Child-Pugh A级患者20例、Child-Pugh B级患者14例、Child-Pugh C级患者18例)及15名慢性乙型肝炎患者(对照组)进行磁共振波谱分析,计算脑代谢物峰下面积Cho(胆碱)、Mi(肌醇)、NAA(N-乙酰天门冬氨酸)、Cr(肌酐)、Glx6(谷氨酰胺复合物)、脑代谢物峰下面积与Cr比值(NAA/Cr、Cho/Cr、Mi/Cr、Glx6/Cr)。结果①Child-Pugh A级组与对照组Mi、Glx6比较,差异有统计学意义。Child-Pugh B级组与Child-Pugh A级组Cho、Mi、Glx6比较,差异有统计学意义(P<0.01);Child-Pugh C级组与Child-Pugh B级组Cho、Mi比较,差异有统计学意义(P<0.01或P<0.05)。②Child-Pugh A级组与对照组Mi/Cr、Glx6/Cr比较,差异有统计学意义(P<0.01);Child-Pugh B组级与Child-Pugh A级组Cho/Cr、Mi/Cr、Glx6/Cr比较,差异有统计学意义(P<0.01或P<0.05);Child-Pugh C级组与Child-Pugh B级组Cho/Cr、Mi/Cr比较,差异有统计学意义(P<0.05)。③肝性脑病(HE)组与非肝性脑病组脑代谢物峰下面积比值Cho/Cr、Mi/Cr、Glx6/Cr比较,差异有统计学意义(P<0.01)。④Child-Pugh分级与Glx6/Cr呈正相关,与Cho/Cr、Mi/Cr呈负相关。⑤肝硬化患者TBil、PT与Cho/Cr、Mi/Cr呈负相关,与Glx6/Cr呈正相关。ALB与Cho/Cr、Mi/Cr呈正相关,与Glx6/Cr呈负相关。ALT与NAA/Cr、Cho/Cr、Mi/Cr、Glx6/Cr无明显相关性。结论肝硬化及肝性脑病患者存在脑代谢物浓度异常改变,可作为早期诊断肝硬化、肝性脑病及评价肝硬化、肝性脑病严重程度的一项指标。Objective To evaluate cerebral metabolic changes in patients with liver cirrhosis and its correlation with Child-Pugh score by MR chemical shift imaging (MRS). Methods Fifty two cases of HBV liver cirrhosis (20 in Child-Pugh A group, 19 in Child-Pugh B group and 14 in Child-Pugh C group) and 15 cases of chronic hepatitis B cases (control group) have been analyzed by 3.0 T MRS. The areas under peak of cerebral metabolites (Cho, Mi, NAA, Cr, Glx6) and the ratio of areas under peak of cerebral metabolites and Cr (NAA/Cr, Cho/Cr, Mi/Cr, Glx6/Cr) have been calculated and analyzed, respectively. Results ①The areas of Mi and Glx6 between Child-Pugh A group and control group showed statistical difference (P < 0.01). The areas of Cho, Mi, Glx6 among Child-Pugh A group, Child-Pugh B group and Child-Pugh C group showed statistical difference (P < 0.01 or P < 0.05). ② It has statistical significance (P < 0.01) for Cho/Cr, Mi/Cr, Glx6/Cr among control group, Child-Pugh A group , Child-Pugh B group and Child-Pugh C group (P < 0.01 or P < 0.05). ③ The ratio of areas under peak of cerebral metabolites and Cr (NAA/Cr, Cho/Cr, Mi/Cr, Glx6/Cr)between HE group and without HE group showed statistical difference (P < 0.01). ④Child-Pugh grading was positively correlated with Glx6/Cr and negatively correlated with Cho/Cr, Mi/Cr. ⑤TBil, PT were negatively correlated with Cho/Cr, Mi/Cr and positively correlated with Glx6/Cr. ALB was positively correlated with Cho/Cr、Mi/Cr and negatively correlated with Glx6/Cr. ALT was not significantly correlated with NAA/Cr, Cho/Cr, Mi/Cr, Glx6/Cr. Conclusions There were cerebral metabolic changes in patients with cirrhosis and HE. The changes can be valid indexes to diagnose early and evaluate the degree of cirrhosis and HE.

关 键 词：肝硬化 肝性脑病 磁共振波谱分析 CHILD-PUGH分级 肝功能 

分 类 号：R575.2[医药卫生—消化系统]