期刊
EUROPEAN RADIOLOGY
卷 27, 期 11, 页码 4699-4709出版社
SPRINGER
DOI: 10.1007/s00330-017-4809-9
关键词
Hepatic encephalopathy; Cirrhosis; Cerebral blood flow; Oxygen extraction fraction; Cerebral metabolic rate of oxygen
资金
- National Natural Science Foundation of China [81671667, 81471644, 81101039]
- China Postdoctoral Science Foundation [2016T90445, 2014T71014, 2015M570436]
- [81322020]
- [81230032]
- [81171313]
Objectives To assess how the severity of hepatic encephalopathy (HE) affects perfusion and metabolic changes in cirrhotic patients and the association between severity and liver disease and anemia. Methods The study groups comprised 31 healthy subjects and 33 cirrhotic patients who underwent MR examinations, and blood and neuropsychological tests. Of the cirrhotic patients, 14 were unaffected, and 11 had covert HE (CHE) and 8 overt HE (OHE). Global cerebral blood flow (CBF), oxygen extraction fraction (OEF), and metabolic rate of oxygen (CMRO2) were noninvasively measured by phase-contrast and T2-relaxation-under-spin-tagging MRI. Correlations were performed between MR measurements, hematocrits, ammonia levels, Child-Pugh scores and neuropsychological test scores. Results Compared with the values in healthy subjects, CBF was higher in unaffected patients, the same in CHE patients and lower in OHE patients, OEF was higher in all patients, and CMRO2 was the same in unaffected and CHE patients and lower in OHE patients. Hematocrit was negatively correlated with CBF and OEF, but not with CMRO2. Ammonia level was negatively correlated with CBF and CMRO2, and Child-Pugh score was negatively correlated with CMRO2. Conclusions The severity-associated alterations in cirrhotic patients indicate that homeostasis of oxygen delivery and oxidative metabolism in HE is regulated by multiple mechanisms. These physiological alterations appeared to be associated with the degree of anemia, ammonia level, and liver function.
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