MR化学位移成像脑代谢物改变与肝硬化的临床相关性

目的 利用磁共振波谱分析（MRS）评价肝硬化患者脑代谢物的异常变化及其与Child-Pugh分级和肝功能指标的相关性。方法 应用3．0T磁共振对52例乙型肝炎肝硬化患者（Child A级20例、Child B级14例、Child C级18例）及15例慢性乙型肝炎患者进行磁共振波谱分析，计算脑代谢物Cho（胆碱）、mI（肌醇）、NAA（N-乙酰天门冬氨酸）、Cr（肌酸）和GLX6（谷氨酰胺复合物）峰下面积、脑代谢物峰下面积与Cr比值（NAA／Cr、Cho／Cr、ml／Cr、Glx6／ml）。结果 Child-Pugh A级患者与对照组mI、GLX6比较，差异有统计学意义，Child-Pugh B级与Child-Pugh A级Cho、mI、GLX6比较，差异有统计学意义（P〈0．01），Child-Pugh C级与Child-Pugh B级Cho、mI比较，差异有统计学意义（P〈0．01或P〈0．05）；Child-Pugh A级与对照组ml／Cr、Glx6/Cr比较，差异有统计学意义（P〈0．01），Child-Pugh B级与Child-Pugh A级Cho／Cr、ml／Cr、Glx6/Cr比较，差异有统计学意义（P〈0．01或P〈0．05），Child-Pugh C级与Child-Pugh B级Cho／Cr、ml／Cr比较，差异有统计学意义（P〈0．05）；肝陛脑病与无肝性脑病患者脑代谢物峰下面积比值（Cho／Cr、ml／Cr、G1x6/Cr）比较，差异有统计学意义（P〈0．01）；Child-Pugh分级与Glx6/Cr呈正相关，与Cho／Cr、ml／Cr呈负相关；肝硬化患者TBIL、PT与Cho／Cr、ml／Cr呈负相关，与Glx6/Cr呈正相关。ALB与Cho／Cr、ml／Cr呈正相关，与Glx6/Cr呈负相关。AIJT与NAMCr、Cho／Cr、ml／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，它可作为肝硬化和肝性脑病早期诊断及程度评价的一项指标。

The changes of cerebral metabolites in MR chemical shift imaging in patients with liver cirrhosis

Objectives To evaluate cerebral metabolite changes in patients with cirrhosis by using MR chemical shift imaging （MRS）. Methods 52 patients with liver cirrhosis （20 with Child-Pugh A,14 with Child-Pugh B,and 18 with Child-Pugh C） and 15 patients with chronic hepatitis B were analysed by 3.0T MRS. The areas under peak of cerebral metabolites （Cho,mI,.NAA,Cr,GLX6）,and the ratio of the areas under peak of cerebral metabolites and Cr（NAA/ Cr,Cho/Cr,ml/Cr,lx6/ml）were calculated. Results The 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 ）;It had 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 （P〈0.01 or P〈0.05）. The ratio of the areas under peak of cerebral metabolites and Cr （NAA/Cr,Cho/Cr,ml/Cr,lx6/ml）between HE group and without HE group showed statistical difference （P〈0.01）. Child-Pugh grading was positively correlated with Glx6/Cr,and negatively correlated with Cho/Cr,ml/Cr. TBIL,PT were negatively correlated with Cho/Cr,ml/Cr,and positively correlated with Glx6/Cr. ALB was positively correlated with Cho/Cr,ml/Cr,and negatively correlated with Glx6/Cr. Conclusion There are cerebral metabolic changes in patients with cirrhosis and HE.