1998 Fiscal Year Final Research Report Summary
Reassessment of the pathogenesis and the management of hepatic encephalopathy : include the cases of subclinical hepatic encephalopathy
| Project/Area Number |
08457173
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| Research Category |
Grant-in-Aid for Scientific Research (B)
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| Allocation Type | Single-year Grants |
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| Section | 一般 |
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| Research Field |
Gastroenterology
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| Research Institution | Iwate Medical University |
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Principal Investigator |
SATO Shunichi Iwate Medical University First Department of Internal Medicine, Professor of Medicine, 医学部, 教授 (10048275)
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| Co-Investigator(Kenkyū-buntansha) |
TAKIKAWA Yasuhiro Iwate Medical University First Department of Internal Medicine, Assistant Profes, 医学部, 助手 (50254751)
KATO Akinobu Iwate Medical University First Department of Internal Medicine, Assistant Profes, 医学部, 講師 (50177424)
SUZUKI Kazuyuki Iwate Medical University First Department of Internal Medicine, Associate Profes, 医学部, 助教授 (00137499)
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| Project Period (FY) |
1996 – 1998
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| Keywords | subclinical hepatic encephalopathy / computer-assisted quantitative neuropsychological tests / positron emission tomography / cerebral glucose metabolism / magnetic resonance imaging / magnetic resonance spectroscopy / pallidal high intensity / glutamine and myoinositol |
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| Research Abstract |
1) Development of computer-assisted quantitative neuroosychological tests : Computer-assisted quantitative neuropsychological tests were newly developed and applied for detection of subclinical hepatic encephalopathy in patients with liver cirrhosis.A new computer system is expected to be clinically useful and also for evaluating the effectiveness of therapeutic maneuvers of subclinical encephalopathy in cirrhotic patients without neuropsychiatiric symptoms. 2) Regional differences of cerebral lucose metabolism (CMR glu) in patients with liver cirrhosis using positron emission tomographv (PET) : The CMRglu in cirrhotic patients with or without subclinical hepatic encephalopathy (SHE) were measured using PET.CMRgIu value in the gray matter of SHE is lower than (hat of control, particularly in the frontal and temporal regions and basal ganglia (p<O.O5, respectively). The CMRglu values in the gray matter of non-SHE and control are almost the same, excepting the basal ganglia. The CMRglu v
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alue in the basal ganglia of non-SHE is higher than that of control and SHE.The CMRglu value in the gray matter of SHE is depressed as corn pared to both non-SHE and control. 3) Clinical relevance of magnetic resonance imagin g( MRI) and magnetic resonance spectroscopy (MRS) for the cirrhotic without overt hepatic encephaIopathv (HE) : To clarify the changes of pallidal high intensity (P1 index) on TI-weighted MRI and brain metabolites on MRS as related to the severity of hepatic functions, the concentrations of blood ammonia (B-NH3) and the tevels of trace elements, patients with liver cirrhosis without HE underwent MRI and proton MRS.P1 index and glutamine are higher in cirrhosis, and myo-inositol is lower than that of control statistically. In cirrhosis, there were statistically negative correlation between B-NH3 and myo-inositol and positive correlation between B-NH3 and glutamine.There was a statistically lower myoinositol and higher P1 index, glutamine as the severity of hepatic functions increased. Furthermore there was a statistically positive correlation between P1 index and Mn.The changes of MR1 and MRS findings already detected in cirrhosis without HE and these abnormalities may be reflect the ammonia and Mn metabolism andthe severity of the hepatic functions. 4) The prevalence and prognosis of subclinical hepatic encephalopathv (SHE) : The prevalence of SHE among patients with liver cirrhosis was estimated 60% and The percentage of the progression to the overt hepatic -encephalopathy is apprbximately 40% of liver cirrhosis with SHE within a yeair Less
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