目的 应用静息态功能磁共振成像(resting-state function magnetic resonance imaging,rs-fMRI)技术结合基于种子点的功能连接(functional connectivity,FC)分析方法研究乙型病毒性肝炎相关的慢加急性肝衰竭(hepatitis B virus-related acute-on-chronic liver failure,HBV-ACLF)伴轻微型肝性脑病(minimal hepatic encephalopathy,MHE)患者和健康对照者(healthy controls,HCs)的默认网络(default mode network,DMN)与全脑的FC是否存在差异,进一步探究HBV-ACLF伴MHE患者认知功能障碍的潜在机制,并以期为HBV-ACLF伴MHE早期诊断提供影像标志物.材料与方法 采用rs-fMRI技术,观察27例HBV-ACLF伴MHE患者和22例HCs静息态下DMN与全脑的FC情况,分析两组间的差异,并与数字符号实验(Digit Symbol Test,DST)评分、数字连接实验 A(Number Connection Test A,NCT-A)评分、蒙特利尔认知评估(Montreal Cognitive Assessment,MoCA)量表评分、血氨及白细胞计数进行相关性分析.结果 与HCs组相比,MHE组右侧颞极、左侧颞下回、右侧枕下回及左侧枕中回FC减低(P＜0.005);MHE组右侧颞极(颞中回)FC值与MoCA评分呈显著负相关(r=-0.394,P＜0.05);MHE组左侧颞下回FC值与血氨呈显著负相关(r=-0.456,P＜0.05).结论 HBV-ACLF伴MHE患者DMN内部功能整合发生了改变,FC减退或中断可能为HBV-ACLF伴MHE患者早期认知减退的病理生理学机制.
A study of the seed-point functional connectivity network for the default mode network in patients with mild hepatic encephalopathy
Objective:Resting-state functional magnetic resonance imaging(rs-fMRI)combined with seed-based functional connectivity(FC)analysis was used to investigate whether there was a difference between the default network(DMN)and the whole brain functional connectivity between patients with hepatitis B virus-related acute-on-chronic liver failure(HBV-ACLF)and minimal hepatic encephalopathy(MHE)and healthy controls(HCs),in order to further explore the underlying mechanism of cognitive dysfunction in HBV-ACLF with MHE patients and HCs,and to provide imaging markers for early diagnosis of HBV-ACLF with MHE.Materials and Methods:Rs-fMRI was used to observed the FC of the DMN with the whole brain in 27 patients with HBV-ACLF with MHE and 22 HCs in the resting state,and analyze the differences between the two groups,and correlation analysis was performed with Digit Symbol Test(DST),Number Connection Test A(NCT-A),Montreal Cognitive Assessment(MoCA)scores,blood ammonia and white blood cell count.Results:Compared with the HCs group,the FC of the right temporal pole(middle temporal gyrus),left inferior temporal gyrus,right inferior occipital gyrus and left middle occipital gyrus was reduced in the MHE group(P＜0.005),the FC value of the right temporal pole was significantly negatively correlated with the MoCA score in the MHE group(r=-0.394,P＜0.05),and the FC score of the left inferior temporal gyrus in the MHE group was significantly negatively correlated with blood ammonia(r=-0.456,P＜0.05).Conclusions:The internal functional integration of DMN in patients with HBV-ACLF with MHE is altered,and the reduction or interruption of FC may be the pathophysiological mechanism of early cognitive decline in patients with HBV-ACLF with MHE.
minimal hepatic encephalopathymagnetic resonance imagingresting state functional connectivitypsychometric testsdefault mode networkcognitive function
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