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目的采用静息状态下血氧水平依赖功能磁共振(BOLD-fMRI)技术和低频振幅(ALFF)及比率低频振幅(fALFF)方法评价轻微型肝性脑病(MHE)患者神经元自发活动改变情况。方法搜集14例MHE患者(MHE组)和14例健康对照者(HC组)行神经心理测试及静息状态下BOLD-fMRI扫描,利用DPARSF软件预处理图像数据并获取ALFF和fALFF进行统计分析。结果与HC组相比,静息态下MHE患者表现为额叶分布为主的全脑多个脑区ALFF及fALFF异常,包括在右颞下回、右颞极/颞中回、左岛叶、右小脑半球后叶等脑区ALFF升高,在双侧额叶多个脑区、双侧楔前叶、右小脑半球后叶等脑区ALFF降低(P<0.05);以及在左侧额叶多个脑区、右中扣带回/额中下回、右楔前叶/后扣带回、右岛叶、右豆状核、左苍白球、脑桥/左小脑半球前叶等脑区fALFF升高,在双侧额前内侧回、右额中回、右颞上回、左小脑半球后叶等脑区fALFF降低(P<0.05)。进一步相关分析发现右楔前叶、左额前内侧回ALFF既与NCT-A评分呈显著负相关(r右楔前叶=-0.764 1,r左额前内侧回=-0.761 8),亦与DST评分呈显著正相关(r右楔前叶=0.868 6,r左额前内侧回=0.723 4,P<0.05)。结论 MHE患者静息态下全脑多个脑区ALFF及fALFF存在异常,尤其是右楔前叶和左额前内侧回异常,可能对MHE检测具有更重要的价值,而联合ALFF及fALFF方法能够更加全面地评价MHE脑神经元活动异常。
Objective To evaluate the changes of spontaneous activity of neurons in patients with mild hepatic encephalopathy (MHE) by resting blood oxygen level dependent functional magnetic resonance (BOLD-fMRI) technique and low frequency amplitude (ALFF) and low frequency amplitude (fALFF) Methods Neuropsychological tests and resting-state BOLD-fMRI were performed in 14 patients with MHE (MHE group) and 14 healthy controls (HC group). DPARSF software was used to preprocess the image data and obtain ALFF and fALFF for statistical analysis. Results Compared with HC group, MHE patients at rest showed abnormal ALFF and fALFF in multiple frontal brain regions, including right inferior temporal gyrus, right temporal / midotemporal left lobe ALFF in brain regions such as right posterior cerebellar hemispheres were significantly increased (P <0.05). ALFF in brain regions such as bilateral frontal lobe multiple brain regions, bilateral wedge anterior lobe, and right cerebellar hemisphere decreased (P <0.05) More than one brain area, the right cingulate gyrus / back middle and lower back, the right wedge anterior / posterior cingulate gyrus, the right island leaf, right lenticular nucleus, left pallidus, pons / left cerebellum anterior brain and other brain regions fALFF increased in the frontal medial frontal gyrus, right middle right back, right upper quadrant, left posterior cerebellar lobes and other brain areas fALFF decreased (P <0.05). Further correlation analysis showed that right anterior wedge leaf, left anterior medial back ALFF both with NCT-A score was significantly negatively correlated (r right wedge anterior lobe = -0.764 1, r left front anterolateral back = -0.761 8), also with DST score was positively correlated (r right wedge anterior lobe = 0.868 6, r left front anterolateral back = 0.723 4, P <0.05). Conclusions There are abnormalities of ALFF and fALFF in multiple brain regions of patients with MHE at rest, especially the anterior right wedge and left anterior medial gyrus, which may have more important value for the detection of MHE. The combination of ALFF and fALFF More comprehensive evaluation of MHE neuronal activity abnormalities.