J HEPATOL:原发性胆汁性肝硬化继发中央神经系统功能障碍以及其与症状间的关系
2010-11-19
来源：医脉通
文献标题：Central nervous system dysfunction in primary biliary cirrhosis and its relationship to symptoms
文献出处：Journal of Hepatology, 2010.12
期刊影响因子：7.818
原发性胆汁性肝硬化（PBC）患者可出现疲劳、记忆减退及睡眠障碍等症状，提示患者可能存在中枢神经系统（CNS）功能障碍。英国的一项研究表明，PBC患者存在中枢激活作用受损和大脑皮层抑制（ICI）异常，提示CNS不能自主控制。ICI、大脑皮层易化（ICF）以及它们之间的平衡跟白天嗜睡症状（PBC患者的一个主要症状）的发生有关。该研究即将发表在12月份的《Journal of Hepatology》杂志上。[J of HEPATOLO, 53(6): 1095-1100]
在专门的PBC临床和神经科学研究机构中，该研究对16例早期PBC患者、8例肝移植后的PBC患者，以及12例年龄相匹配的对照患者进行研究。在这些患者中，外周和中枢疲劳选用随意收缩叠加法来测量。通过应用双脉冲经颅磁刺激来评估ICI和ICF。
PBC患者在运动疲劳发生前，中枢激活作用较对照组明显减低（平均值为86.6.8％(± 12.75)vs.95.2％（± 7.4）; p <0.05)）而其反应变异性较对照组大。运动时中枢激活作用下降以及外周疲劳是正常的。PBC患者ICI显著降低，净抑制超过易化的患者白天嗜睡更为显著。移植和未行肝移植患者具有相似的中枢激活、ICI和ICF变化。
医脉通推荐英文摘要
J Hepatol. 2010, 53(6):1095-1100.
Central nervous system dysfunction in primary biliary cirrhosis and its relationship to symptoms.
Claire McDonald, Julia Newton, H. Ming Lai, Stuart N. Baker, David E. Jones
BACKGROUND & AIMS
Primary biliary cirrhosis (PBC) is associated with fatigue, memory impairment, and sleep disturbances. These symptoms suggest the possibility of underlying central nervous system (CNS) dysfunction. During exercise, fatigue develops due to muscular processes (peripheral fatigue) and decreased neurological activation of the muscle (central fatigue). In this study we objectively quantify central and peripheral fatigue in PBC and investigate the integrity of cortical inhibitory and excitatory circuits. Finally, we determine the relationship of these indices to the symptoms of PBC.
METHODS
16 early-stage PBC patients, 8 post-liver transplant PBC patients, and 12 age-matched controls were studied at the Specialist PBC clinic and neuroscience research unit. In these patients, twitch interpolation was used to measure peripheral and central fatigue. Paired-pulse trans-cranial magnetic stimulation was used to assess intra-cortical inhibition (ICI) and facilitation (ICF).
RESULTS
PBC patients had a significantly lower central activation before fatiguing exercise (mean 86.6.8% (±12.75) vs. 95.2% (±7.4); p<0.05) and a greater response variability than controls. The decline in central activation during exercise and peripheral fatigue were normal. ICI was significantly reduced in PBC patients and daytime somnolence was greater in patients where net inhibition exceeded facilitation. Transplanted and non-transplanted patients had similar central activation, ICI, and ICF.
CONCLUSIONS
PBC patients have impaired central activation and abnormal ICI, suggesting CNS abnormalities beyond voluntary control. Transplanted and non-transplanted patients show similar abnormalities raising interesting questions about the mechanisms underpinning these changes and the permanence of neurological dysfunction in PBC. ICI and ICF and the balance between them are related to daytime somnolence (an important symptom in PBC).
文献来源
McDonald C, Newton J, Lai HM,
Claire McDonald, Julia Newton, H. Ming Lai,et al. Central nervous system dysfunction in primary biliary cirrhosis and its relationship to symptoms. J Hepatol. 2010, 53(6):1095-1100.[PubMed摘要 | 期刊来源]
(本网站所有内容，凡注明来源为“医脉通”，版权均归医脉通所有，未经授权，任何媒体、网站或个人不得转载，否则将追究法律责任，授权转载时须注明“来源：医脉通”。本网注明来源为其他媒体的内容为转载，转载仅作观点分享，版权归原作者所有，如有侵犯版权，请及时联系我们。)
