轻微型肝性脑病患者认知功能损害的局部一致性改变:一项基于fMRI的研究  

Homogeneity of cognitive function altered in patients with minimal hepatic encephalopathy:A fMRI based study

作　　者：杨旭宏 黄雪莹[2] 刘文潇 王明磊[2] 葛鑫 张伟[2] 党佩 丁向春[3] 王晓东[2,4] YANG Xuhong;HUANG Xueying;LIU Wenxiao;WANG Minglei;GE Xin;ZHANG Wei;DANG Pei;DING Xiangchun;WANG Xiaodong(Ningxia Medical University School of Clinical Medicine,Yinchuan 750001,China;Department of Radiology,General Hospital of Ningxia Medical University,Yinchuan 750001,China;Department of Infectious Diseases,General Hospital of Ningxia Medical University,Yinchuan 750001,China;Key Laboratory of Craniocerebral Diseases of Ningxia Medical University,Yinchuan 750001,China)

机构地区：[1]宁夏医科大学临床医学院,银川750001 [2]宁夏医科大学总医院放射科,银川750001 [3]宁夏医科大学总医院感染疾病科,银川750001 [4]宁夏医科大学颅脑疾病重点实验室,银川750001

出　　处：《磁共振成像》2022年第5期77-81,88,共6页Chinese Journal of Magnetic Resonance Imaging

基　　金：宁夏自然科学基金(编号:2022AAC03487);宁夏回族自治区科技重点研究计划(编号:2019BEG03037);宁夏医科大学颅脑疾病重点实验室神经科学优势学科群(编号:LNKF202109)。

摘　　要：目的探究轻微型肝性脑病(minimal hepatic encephalopathy,MHE)患者脑区局部一致性(regional homogeneity,ReHo)改变对认知功能的影响。材料与方法前瞻性纳入25例乙肝肝硬化伴MHE患者(MHE组)、27例无MHE的乙肝肝硬化患者(肝硬化组)和30例性别、年龄、受教育程度相匹配的健康对照者(健康对照组)。所有受试者均行颅脑静息态血氧水平依赖功能磁共振成像(blood oxygenation level-dependent functional magnetic resonance imaging,BOLD-fMRI)扫描,将原始图像经过处理后得到ReHo脑图,用独立样本t检验分别比较健康对照组、肝硬化组和MHE组三组之间ReHo差异的脑区。采用Person相关分析法分析MHE组脑区ReHo与蒙特利尔认知评估量表(Montreal Cognitive Assessment,MoCA)评分的相关性。结果与健康对照组和肝硬化组相比,MHE组数字连接试验A(Number Connection Test-A,NCT-A)量表评分显著升高、数字符号试验(Digital Symbol Test,DST)及MoCA评分降低,差异均有统计学意义(P<0.01)。与健康对照相比,MHE组右侧额中回、颞中回、颞下回及双侧中央旁小叶的ReHo显著降低,左侧楔前叶ReHo升高,差异均有统计学意义(P<0.05)。相关分析显示MHE组MoCA评分与左侧中央前回、左侧颞中回及部分枕部的平均ReHo值呈负相关(P<0.05),与右侧缘上回的平均ReHo值呈正相关(P<0.05)。结论MHE患者认知障碍的发生可能与脑区ReHo的改变有关。Objective:To explore the effects of regional homogeneity(ReHo) changes on cognitive function in patients with minimal hepatic encephalopathy(MHE).Materials and Methods:Twenty-five patients with hepatitis B cirrhosis complicated with MHE(MHE group),27 patients with hepatitis B cirrhosis without MHE(cirrhosis group) and 30 healthy control subjects(healthy control group) with matching gender,age and educational level were collected.All the subjects underwent blood oxygenation level dependent functional magnetic resonance imaging(BOLD-fMRI) scanning.The ReHo brain map was obtained after the original images were processed.Brain regions with ReHo differences among the healthy control group,the liver cirrhosis group and the MHE group were compared with Student’s t-test.The correlation between the Re Ho value of cerebral regions in the MHE group and the Mo CA scale score was analyzed by Person correlation analysis.Results:Compared with the healthy control group and the liver cirrhosis group,the NCT-A score of the MHE group was significantly increased,and the DST,MoCA scale scores were significantly decreased,with statistical difference(P<0.01).Compared with the healthy control,the ReHo of the right middle frontal gyrus,middle temporal gyrus,inferior temporal gyrus and bilateral para-central lobule was significantly reduced in the MHE group,and the ReHo of the left anterior wedge lobe was increased,with statistical difference(P<0.05).Correlation analysis showed that in the MHE group,the MoCA score were negatively correlated with average ReHo value of the left anterior central gyrus,the left superior temporal gyrus,and part of the occipital region(P<0.05),and were positively correlated with the average ReHo value of the right superior marginal gyrus(P<0.05).Conclusions:The cognitive impairment in patients with MHE may be related to the changes of ReHo in the cerebral region.

关 键 词：轻微型肝性脑病 认知功能 局部一致性 血氧水平依赖 功能磁共振成像 数字连接实验A 数字符号实验 

分 类 号：R445.2[医药卫生—影像医学与核医学] R747.9[医药卫生—诊断学]