| Objective:This study was to use MRS to explore cerebral metabolic changes after TIPS, analyze changes of Glx/Cr, NAA/Cr, Cho/Cr, mIns/Cr in patients with hepatic encephalopathy after TIPS. Probe the correlation between blood ammonia levels and Glx/Cr, NAA/Cr, Cho/Cr, mIns/Cr in hepatic encephalopathy patients. Analysis of different liver function classification effects on postoperative hepatic encephalopathy.Methods:Choice in 20 patients with indications of TIPS, all cases by the digital connection test A (Number connection test A, NCT-A) and digit symbol test(Digit symbol test, DST) check without hepatic encephalopathy, and no obvious abnormal in MRI scan. Detection the venous blood ammonia, liver function, head MRI and MRS scan before preoperative and One week after the operation. Use of Philips’s post-processing software to get Glx/Cr, NAA/Cr, Cho/Cr, mIns/Cr’s value.The 20 patients according to ChildA, B, C class divided into groups A, B, C group, then according to the presence or absence of postoperative hepatic encephalopathy are divided into HE group and non-HE group. Using SPSS 22.0 software for statistical analysis, comparison of changes after HE group and NHE group on conventional MRI scan. Compare the changes of Glx/Cr, NAA/Cr, Cho/Cr, mIns/Cr between HE group and NHE group. Calculate the rate of change of Glx/Cr, NAA/Cr, Cho/Cr, mIns/Cr of HE group. Using ROC to calculate AUC, find the boundary value of the Glx/Cr, NAA/Cr, Cho/Cr, mlns/Cr’s rate of change to diagnosis the HE, and comparison the diagnosis efficiency. Probe the correlation between blood ammonia levels and Glx/Cr, NAA/Cr, Cho/Cr, mIns/Cr in hepatic encephalopathy patients. Analysis of different liver function classification effects on postoperative hepatic encephalopathy.Result:1. Part of TIPS postoperative patients with hepatic encephalopathy and non-hepatic encephalopathy showed high signal on T1WI in basal ganglia.There was statistical significance in abnormal signal on T1WI in basal ganglia between hepatic encephalopathy group and non-hepatic encephalopathy group(P<0.05).2. There was elevated Glx/Cr (P<0.05) and decreased mlns/Cr (P＜0.05) in TIPS postoperative hepatic encephalopathy patients, but Cho/Cr and NAA/Cr no change after preoperative(P>0.05). Further statistical postoperative patients with hepatic encephalopathy that Glx/Cr, mIns/Cr two groups of data,to analyze diagnostic test on the rate of change of preoperative and postoperative, that Glx/Cr, mIns/Cr diagnostic test results of AUC were statistically significant(P<0.05), and the AUC were 0.806, 0.729 respectively, that diagnosis effect of Glx/Cr was good than mIns/Cr. TIPS postoperative patients with hepatic encephalopathy and non-hepatic encephalopathy Glx/Cr, mIns/Cr rate of diagnosis threshold were 111.7%,-39.8% respectively, sensitivity 88.9%、66.7% respectively, the specific degree 84.6%、76.9% respectively.3. Compared preoperative results with postoperative results of non-hepatic encephalopathy group,found Glx/Cr slightly higher than preoperative, mIns/Cr, Cho /Cr slightly lower than preoperative, but the difference were not statistically significance(P>0.05). 4. The blood ammonia of TIPS postoperative hepatic encephalopathy patients wereincreased than preoperative, the difference was statistically significant(P<0.05), hepatic encephalopathy postoperative blood ammonia levels and Glx/Cr levels were positively correlated(P<0.05), but had no correlation with NAA/Cr, Cho/Cr, mIns/Cr. 5. Patients of TIPS preoperative according to Child classification of liver function, grouped by brain metabolic changes, each groups comparison showed Glx/Cr elevated in level C patients than A, B level(P<0.05), mIns/Cr decreased(P<0.05). The difference of cerebral metabolic changes was no statistically significant between Child A and Child B(P>0.05).Conclusion:1. Patients with cirrhosis and hepatic encephalopathy had metabolic disorder in brain, MRI showed that part of patients may had a high signal on T1WI in basal ganglia region, mainly in the globus pallidus, may be associated with manganese deposit.2.’H-MRS can noninvasively detect metabolite levels in brain cells, the cerebral metabolic of TIPS postoperative HE patients had significant change than preoperative,MRS showed that increased Glx/Cr ratios and decreased mlns/Cr and Cho/Cr ratios; and increased Glx/Cr ratios and decreased mIns/Cr are more sensitive.3. Diagnosis of postoperative whether HE happened that the rate of change of two groups of data Glx/Cr, mIns/Cr diagnosis threshold were 111.7%、-39.8% respectively, sensitivity 88.9%、66.7% respectively, the specific degree 84.6%,76.9% respectively,and the diagnosis effect of Glx/Cr was good than mIns/Cr.4. MRS examination can distinguish cirrhosis group of non-HE, HE cirrhosis group. MRS diagnosised TIPS postoperative of hepatic encephalopathy, particularly important in the early diagnosis of hepatic encephalopathy, minimal hepatic encephalopathy.5. HE postoperative blood ammonia increased significantly compared with the preoperative,postoperative blood ammonia level was closely related to the level of Glx in the brain, showed that blood ammonia was one of the important reasons of cirrhosis in patients with HE.6. Description preoperative liver function had a significant effect on postoperative changes in brain metabolism, MRS examination was helpful to distinguish the severity of liver cirrhosis, but to the Child the distinction between A and B level was still difficult. |
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