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目的:利用~1H-MRS研究慢性肝病脑部代谢改变,并探讨~1H-MRS评估慢性肝病脑部代谢异常与肝硬化Child-Pugh分级的相关性。方法:选取经临床确诊为慢性肝炎肝硬化患者42例(child A 19例,child B14例,child C 9例)及健康志愿者15例(对照组),行磁共振平扫及磁共振单体素~1H-MRS检查,计算相关代谢物N-乙酰天门冬氨酸(NAA)、谷氨酰胺复合物(Glx)、胆碱(Cho)、肌醇(mI)和肌酸(Cr)的峰下面积及前四项指标与Cr的比值(NAA/Cr、Glx/Cr、Cho/Cr、mI/Cr),并进行统计学分析,同时对相关代谢物的变化与肝硬化Child-Pugh分级及肝硬化Child-Pugh分级与肝性脑病的关系进行相关性分析。结果:~1HMRS分析显示与正常对照组相比,慢性肝炎肝硬化组Glx/Cr值升高,Cho/Cr与mI/Cr值降低,且差异均有统计学意义(P<0.05);不同程度肝硬化病例组对比显示,Glx/Cr值均随着肝硬化程度加重而增大,且Glx/Cr值的差异在child A、child B、child C组中均有统计学意义(P<0.05);肝性脑病(HE)组与非肝性脑病组脑代谢物峰下面积比值Glx/Cr、Cho/Cr、mI/Cr比较,差异有统计学意义(P<0.05);Child-Pugh分级与Glx/Cr呈正相关,与Cho/Cr、mI/Cr呈负相关;随着肝硬化程度加重,肝性脑病出现概率越高,差异有统计学意义(P<0.05)。结论:~1H-MRS作为一种无创性的评价手段,能够反映慢性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,在一定程度上评估肝性脑病与肝硬化分级具有相关性。
OBJECTIVE: To study the changes of brain metabolism in chronic liver disease by ~ 1H-MRS and to investigate the correlation between ~ 1H-MRS and the Child-Pugh classification of liver cirrhosis. Methods: Forty-two patients (19 cases of child A, 14 cases of child B and 9 cases of child C) and 15 cases of healthy volunteers (control group) were enrolled in the study. Cholesterol-induced liver cirrhosis 1H-MRS was used to calculate the peaks of related metabolites NAA, Glx, Cho, mI and creatine (Cr) (NAA / Cr, Glx / Cr, Cho / Cr, mI / Cr) of the first four indicators and the area of the liver cirrhosis were calculated and compared with the changes of the related metabolites and the Child-Pugh classification of liver cirrhosis Correlation analysis of the relationship between Child-Pugh cirrhosis and hepatic encephalopathy. Results: ~ 1HMRS analysis showed that Glx / Cr and Cho / Cr and mI / Cr decreased in patients with chronic hepatitis and cirrhosis compared with the control group, and the difference was statistically significant (P <0.05) The comparison of patients with cirrhosis showed that Glx / Cr increased with the degree of liver cirrhosis, and the difference of Glx / Cr was statistically significant in child A, child B and child C (P <0.05) (P <0.05). There was significant difference in the ratio of peak area of brain metabolites between hepatic encephalopathy (HE) group and non-hepatic encephalopathy group (P <0.05) Glx / Cr, but negatively correlated with Cho / Cr and mI / Cr. With the severity of liver cirrhosis, the higher the probability of occurrence of hepatic encephalopathy was, the difference was statistically significant (P <0.05). Conclusion: 1H-MRS as a noninvasive evaluation method can reflect abnormal changes of brain metabolites in patients with chronic liver cirrhosis and hepatic encephalopathy. It can be used as an early diagnosis of cirrhosis, hepatic encephalopathy and evaluation of liver cirrhosis, hepatic An indicator of the severity of encephalopathy, to a certain extent, to assess the relevance of hepatic encephalopathy and cirrhosis grading.