Cerebral Hemodynamics And Cognitive Function In Cirrhotic Patients With Hepatic Encephalopathy

Aims: To investigate ammonia and cerebral hemodynamics in cirrhotic patients with hepatic encephalopathy(HE),meanwhile,to observe effects of treatments on them,and correlations among ammonia,cerebral hemodynamics and cognitive function in patients with minimal HE(MHE).Methods: 1.There were four groups: the health(group 1),cirrhosis without HE(group 2),cirrhosis with MHE(group 3,abnormal results in both NCT-A and DST tests which reflecting cognitive function indicated MHE diagnosis)and cirrhosis with overt HE(OHE)(group 4).Ammonia,creatinine,total bilirubin,albumin,prothrombin time and cerebral hemodynamics(by transcranial doppler,TCD,including Vp、Vm、Vd、PI and RI)were assessed on the day of enrolment.2.After completing all of the above examinations,patients in group 3 were subsequently randomized to two subgroups: the control(group A,accepted basic liver treatments for two months)and the treated(group B,treated with lactulose based on basic liver treatments for two months),and they were re-tested for ammonia and TCD after treatment,and compared the changes in these indexes of the two groups before and after treatment.3.Compare the correlations among ammonia,cerebral hemodynamics and cognitive function in patients with MHE.Results: 1.There were statistically significant differences in ammonia,Vm,Vd,PI and RI among group 1,2,3 and 4 before treatment,and both ammonia,PI and RI paralleled the severity of HE(P<0.05).2.In group B,Vd increased,ammonia,PI and RI declined following treatment(P<0.05),while there was no differences in group A(P>0.05).3.In patients with MHE,there was no correlation observed between ammonia and Vm(P>0.05),but there was positive correlation between ammonia and PI,RI,also NCT-A(P<0.05).In contrast,there was negative correlation between ammonia and Vd,DST(P<0.05).In addition,there was no correlation observed between Vm and NCT-A,DST(P>0.05),however we did detect negative correlation between Vd and NCT-A,and positive correlation between Vd and DST(P<0.05),which was opposite to PI and RI(P<0.05).Conclusions: This study revealed that in cirrhotic patients with HE,ammonia,PI and RI increased and cerebral blood flow velocity slowed down which indicated impairment of systolic and diastolic cerebral autoregulation in patients with HE.At the same time,ammonia,PI and RI paralleled the severity of HE.After treatment with lactulose,ammonia level and cerebral hemodynamics improved and there were tight correlations among ammonia,cerebral hemodynamics and cognitive functionin patients with MHE.