中文摘要：

目的 利用静息态fMRI观察轻微肝性脑病（MHE）患者全脑功能连接的改变,并通过ROC曲线分析差异脑区连接在鉴别MHE和无MHE的肝硬化患者中的价值.方法 收集30例MHE患者（MHE组）、32例无MHE的肝硬化患者（无MHE组）和49名健康志愿者（正常对照组）行静息状态下的fMRI扫描,利用全脑功能连接分析方法对受试者的功能MR数据进行分析,使用方差分析观察3组受试者间的总体差异,采用Post-hoc检验观察MHE和无MHE的肝硬化患者间脑功能连接的差异.通过ROC曲线分析2个患者组间差异脑区的功能连接在其鉴别诊断中的价值.结果 3组受试者全脑脑区间的功能连接存在广泛差异,共115对脑区间的连接方差分析差异有统计学意义（P值均＜0.05）.与无MHE的肝硬化患者相比,MHE患者以下6对脑区间的功能连接降低,包括：左侧颞上回-右侧额下回眶部、左侧颞横回-左侧中央盖区、左侧颞横回-右侧嗅皮质、左侧海马-右侧杏仁核、左侧壳核-右侧壳核和左侧颞上回颞极区-右侧颞中回颞极区（t值为-4.41 ～-3.82,P值均＜0.01）.ROC曲线分析示左侧海马-右侧杏仁核间功能连接鉴别MHE和无MHE的肝硬化患者的曲线下面积为0.78（95％CI 0.66 ～ 0.90）,具有最高的区分价值,界值为0.56时敏感度为73％,特异度为81％.结论 静息态fMRI全脑功能连接分析方法可用于观察MHE患者脑功能的改变模式,有潜力用于MHE的早期诊断.

英文摘要：

Objective To investigate the alteration of the whole brain functional connectivity in patients with minimal hepatic encephalopathy（MHE） by using resting-state functional MRI,and to explore its role in distinguishing the MHE from cirrhotic patients without MHE by using the receiver operator characteristic（ROC） curve.Methods Thirty cirrhotic patients with MHE,32 cirrhotic patients without MHE （non-MHE）,and 49 healthy controls underwent standard resting-state functional MRI scan.Whole brain functional connectivities were compared with analysis of variance test to observe the difference among three groups,and then compared with Post-hoc test to investigate the changes between MHE and non-MHE groups.Results There were widespreadly different functional connectivities among three groups.All 115 functional conenctivities showed significant difference among three groups（all P＜0.05）.Compared with non-MHE patients,MHE patients showed 6 decreased functional connectivity in the following brain regions （P＜0.05）：between left supper temporal gyrus-right orbitofrontal cortex,left Heschl＇s gyrus-left Rolandic operculum,left Heschl＇s gyrus-right olfactory cortex,left hippocampus-right amygdala,left putamen-right putamen,and left temporal pole of supper temporal gyrus-right temporal pole of middle temporal gyrus （t=-4.41-3.82,P＜0.01）.ROC analysis demonstrated that the left hippocampus-right amygdala had the highest value for differentiating MHE from non-MHE group（AUC=0.78,95％CI 0.66-0.90） with a cutoff value=0.56,sensitivity=73％ and specificity=81％）.Conclusion Functional connectivity analysis can be used to observe the functional changes in MHE patient,and has a potential for the early diagnosis of MHE.