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目的探讨3组肝硬化病人在静息状态下脑功能连通性(FC)的差别,3组包括无严重肝性脑病(HE)(OHE)者、有轻度HE者(MHE)和曾有OHE现已恢复者,探讨以往多次发作的OHE是否比当前的MHE更多导致了目前尚无OHE的病人的脑功能障碍。材料与方法本研究通过机构伦理委员会审核并获得知情同意书。健康对照组在静息状态下的功能MR数据与多组肝硬化病人的进行比较:(a)无MHE和先前OHE的病人;(b)有MHE但无先前OHE的病人;(c)之前有OHE的病人。应用独立分量分析来识别确认默认模式网络(DMN)的最佳分量。应用单向方差分析检测不同组之间FC的差别。应用Pearson相关分析确定FC与神经认知功能的关系。结果在DMN中有2个重要区域,包括楔前叶、扣带后回和左内侧额回,4组病人之间的FC有显著差别。在对照组、未有HE组、现有MHE组,发现其脑内2个区域的FC有逐渐下降的趋势,之前患有OHE组的脑内2个区域的FC则显著下降。肝硬化病人的FC与神经认知功能彼此有显著的相关性。结论在DMN中静息状态的FC下降与MHE病人和OHE恢复后病人的神经认知功能损害有关。相比当前MHE的作用,之前的OHE更可能与存在潜在OHE病人的脑功能障碍有关。
Objective To investigate the difference of functional connectivity (FC) in resting state of three groups of patients with cirrhosis, three groups including those without severe hepatic encephalopathy (HEE), with mild HE (MHE) and those with OHE Now resumed, to explore whether the previous multiple episodes of OHE more than the current MHE lead to the current lack of OHE in patients with brain dysfunction. Materials and Methods The study was audited by an institutional ethics committee and informed consent forms were obtained. Functional MR data at rest in healthy controls compared to patients with multiple cirrhosis: (a) patients without MHE and previous OHE; (b) patients with MHE but without previous OHE; (c) previous OHE patients. Independent component analysis is used to identify the best component to confirm the default mode network (DMN). One-way ANOVA was used to detect differences in FC between different groups. Pearson correlation analysis was used to determine the relationship between FC and neurocognitive function. Results There were two important regions in DMN, including the anterior wedge, the anterior cingulate gyrus and the left medial frontal gyrus. There was a significant difference in FC among the four groups. In the control group, there was no HE group or the existing MHE group, and the FCs of two regions in the brain were gradually decreased. However, the FC in the two regions of the brain that previously had the OHE group was significantly decreased. There is a significant correlation between FC and neurocognitive function in cirrhotic patients. Conclusions The decreased resting FC in DMN is associated with impaired neurocognitive function in patients with MHE and OHE after recovery. Compared to the current role of MHE, previous OHE is more likely to be associated with brain dysfunction in patients with underlying OHE.