肝硬化血锰水平与脑MRI征象的相关性  

Correlation between blood Manganese level and brain MRI findings of cirrhosis

作　　者：李向荣[1] 龙莉玲[1] 姜岳明[2] 傅雪[2] 

机构地区：[1]广西医科大学第一附属医院放射科,广西南宁530021 [2]广西医科大学公共卫生学院,广西南宁530021

出　　处：《中国医学影像技术》2009年第11期1984-1987,共4页Chinese Journal of Medical Imaging Technology

基　　金：广西自然科学基金(桂科自0640129)

摘　　要：目的研究肝硬化血锰水平变化与脑苍白球MRIT1WI信号的关系,探讨MRI在肝硬化锰代谢紊乱所致锥体外系神经功能障碍中的应用价值。方法选择33例经临床和(或)手术病理确诊为肝硬化的患者和20名健康志愿者进行MRI和血锰水平测定。测量苍白球指数PI并分析肝硬化组PI值与血锰和肝功能Child-Pugh积分的相关性。5例伴帕金森综合征的肝硬化患者(其中3例行肝移植)应用UPDRS量表评估帕金森症状并进行治疗前后对比研究。结果33例肝硬化中,28例(84.85%)苍白球T1WI呈高信号,20例(76.92%,20/26)血锰水平不同程度升高。PI值和血锰均值两组间比较差异有统计学意义。PI值与血锰水平和Child-Pugh积分间有明显相关性(r=0.81,r=0.53)。伴有帕金森综合征的肝硬化患者治疗前后对比研究显示苍白球T1WI高信号随肝功能改善而减轻,于肝移植成功后5～6个月完全消失,患者锥体外系神经症状和体征均有不同程度缓解,相应UPDRS评分改善。结论苍白球T1WI高信号与肝硬化代谢紊乱所致锰蓄积有关,并有可能导致锥体外系神经功能损害。血锰浓度和MRI是目前监测体内锰水平的较好指标。Objective To observe the relationship between changes of blood Manganese（Mn）level and signal intensity on T1WI of brain globus pallidus,and to explore the application value of MRI on detecting extrapyramidal system dysfunction induced by Mn metabolism disorder in liver cirrhosis.Methods Thirty-three patients diagnosed as liver cirrhosis based on clinical and（or）surgical pathology and 20 healthy volunteers were recruited into the cirrhosis and control group,respectively.MR was performed and blood Mn levels were measured.Pallidal index（PI）was calculated,and the correlation of PI value with blood Mn level and Child-Pugh score of liver function in cirrhosis group was analyzed.Five cirrhosis patients with Parkinson＇s syndrome（3 of them were accepted liver transplantation）were evaluated with UPDRS（unified Parkinson＇s disease rating scale）before and after treatment.Results Hyperintensity T1WI signals in globus pallidus were detected in 84.85%（28/33）,whereas blood Mn concentration increased in 76.92%（20/26）of cirrhosis patients.There were significant differences of PI and blood Mn levels between cirrhosis group and control group.Positive correlations were found between PI and blood Mn level（r=0.81）,as well as PI and Child-Pugh scores（r=0.53）.Hyperintensities of T1WI signal in globus pallidus on the 5 patients with Parkinson＇s syndrome displayed attenuation of improvement of liver function,and abnormal signal intensity disappeared 5-6 months after successful liver transplantation,while improvement of extrapyramidal system dysfunction symptoms and signs and UPDRS scores were observed.Conclusion The hyperintensity of T1WI signal in globus pallidus may relevant to Mn accumulation induced by liver dysfunction which also may result in damages to extrapyramidal system.Blood Mn concentration and MRI alteration may be sensitive indices in monitoring internal Mn level.

关 键 词：磁共振成像 锰 肝硬化 

分 类 号：R657.31[医药卫生—外科学] R445.2[医药卫生—临床医学]