Cerebral Hemodynamics and Cognitive Function in Cirrhotic Patients with Hepatic Encephalopathy

Zhou, Yuqing; Dong, Qian; Zhang, Rong; Zhou, Shunfeng; Li, Linqiang; Cheng, Keran; Kong, Rui; Yu, Qiang; Xu, Shizan; Li, Jingjing; Li, Sainan; Jiao, Feng; Wu, Liwei; Liu, Tong; Chen, Kan; Xia, Yujing; Lü, Jie; Zhou, Yingqun; Guo, Chuanyong

doi:10.1155/2016/8485032

Cited by 9 publications

(10 citation statements)

References 45 publications

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“…Patients with decompensated cirrhosis or HE have a higher risk of cerebral hypoperfusion related with microvascular damage and the ability for autoregulation, which is and important feature for systemic blood pressure sudden changes, particularly hypotension, which can promotes HE [84]. These findings were similar to those reported by two separated groups, one located in Turkey, were 50 decompensated group of cirrhotic patients was compared with 50 healthy volunteers using the same TCD approach [85]; while other in China recruited a healthy control group (n = 40), a cirrhotic without HE group (n = 52), a cirrhotic with MHE group (n = 21) and a cirrhotic with OHE group (n = 19) [86]. Here, in the first case, the authors analyzed the spectra signal derived from the systolic velocity, diastolic Astrocyte Pathophysiology in Liver Disease http://dx.doi.org/10.5772/intechopen.72506 velocity, mean flow velocity (MFV in cm/s), pulsatility, and the resistive indexes (PI = Peak sys-…”

Section: Clinical Data In Osmoregulation and Systemic Infections In Csupporting

confidence: 77%

“…Patients with cirrhosis had a lower MFV compared to control healthy group, while cirrhotic patients had a higher PI and RI values and a positive correlation exists with the model for endstage liver disease (MELD) score and the RI values of patients with ascites, which were higher than those without ascites [85]. In the second case, authors found that mean velocity (V m ), V d , PI, and RI, as well as the serum ammonia levels, were decreased in the group of cirrhotic patients with MHE subject to lactulose treatment, when compared with the placebo group, while a positive correlation was found between ammonia and PI, RI, cognitive test results and V d ; authors propose that cerebral hemodynamics is related with the severity of HE and that lactulose treatment is able to significantly improve this parameter in cirrhotic patients [86].…”

Section: Clinical Data In Osmoregulation and Systemic Infections In Cmentioning

confidence: 89%

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Astrocyte Pathophysiology in Liver Disease

Pérez‐Monter¹,

Torre-Delgadillo²

2018

Astrocyte - Physiology and Pathology

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Liver disease is one of the major chronic disabilities around the world. It is known that global casualties are increasing because of virus C infection, alcohol consumption, or nonalcoholic circumstances. One of the main derived comorbidities of liver disease is the hepatic encephalopathy (HE), a severe neuropsychological syndrome derived from the acute or chronic liver disease. A key feature accounting for HE symptoms in cirrhotic patients is brain edema, which is triggered by hyperammonemia. In basal conditions, ammonia can be metabolized in the central nervous system (CNS) by astrocytes, which synthetize glutamine using ammonia and glutamate as substrates. In hyperammonemic conditions, astrocytes synthetize large amounts of glutamine generating a hyperosmotic condition, inducing these cells to become swollen in shape, invoking the characteristic symptom clinically manifested in patients with HE, as brain edema; this condition is regulated by water channels called aquaporins (AQPs) and by other molecules such as myoinositol. Experimental evidence suggests that some small non-coding RNAs may regulate AQPs expression both in vivo an in vitro and that some pharmacological interventions improve cognitive impairment in cirrhotic patients. It is undeniable that astrocytes and the different signaling pathways beneath its plasma membrane play a crucial role in liver disease-derived HE and represent some of the novel pharmacological targets to treat comorbidities of the liver disease.

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Section: Clinical Data In Osmoregulation and Systemic Infections In Csupporting

confidence: 77%

Section: Clinical Data In Osmoregulation and Systemic Infections In Cmentioning

confidence: 89%

Astrocyte Pathophysiology in Liver Disease

Pérez‐Monter¹,

Torre-Delgadillo²

2018

Astrocyte - Physiology and Pathology

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“…A subgroup analysis was undertaken according to Child–Pugh grade, which found that NCT‐A scores in the Child–Pugh A, B, and C groups were all significantly higher than that in the control group. As with ammonia levels, NCT‐A values showed an increasing trend with the decrease in liver compensatory ability; moreover, the worse the liver compensatory ability, the worse the cognitive ability of the patients, and the more prone they were to HE …”

Section: Discussionmentioning

confidence: 96%

Study of the sleep quality and psychological state of patients with hepatitis B liver cirrhosis

Xiao

Han

et al. 2017

Hepatology Research

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“…In addition, the results of the present study may prompt a novel method to study other complications of cirrhosis, including portal hypertension (30), hepatic encephalopathy (31) and hepatocellular carcinoma (32,33). Table IV.…”

Section: Discussionmentioning

confidence: 82%

Clinical value of urinary retinol‑binding protein in ascites due to cirrhosis

Xia

et al. 2017

Exp Ther Med

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Abstract. The aim of the present study was to explore the clinical value of urinary retinol-binding protein (RBP) level in the prognosis of cirrhotic ascites by assessment of the RBP levels prior to and following ascites treatment. The levels of urinary RBP, urinary microalbumin (mAlb), serum urea nitrogen (urea) and serum creatinine (Cr), and the estimated glomerular filtration rate (eGFR) were measured in 90 patients with cirrhosis and ascites hospitalized in a single institution between May 2011 and January 2012, and in 30 healthy controls. The levels of urinary mAlb, serum urea and serum Cr were higher in the cirrhotic patients compared with the healthy controls (P<0.05). Urinary RBP levels were significantly higher and eGFR was significantly lower in the liver cirrhosis group compared with the healthy control group (P<0.01). Urinary RBP, urinary mAlb, serum urea and serum Cr increased and eGFR decreased as the severity of the ascites increased (P<0.05). Urinary RBP was significantly higher in patients whose ascites did not respond or was refractory compared with those in whom it subsided (P<0.05), exhibiting a gradual increase over time in the former and a gradual reduction over time in the latter group (P<0.05). Increased urinary RBP and decreased eGFR in the early stage of cirrhosis ascites suggested impaired renal function, which serves a role in the process of ascites formation. These results indicated that urinary RBP is a sensitive indicator of early renal injury in patients with ascites due to cirrhosis and is closely associated with the progression of cirrhotic ascites. IntroductionCirrhosis is a chronic, progressive, diffuse disease caused by a variety of factors, including hepatitis B virus, alcoholic liver disease and autoimmune liver disease (1-3). Liver cirrhosis mortality increased from 1.54% of global mortality in 1980 to 1.95% in 2010 (4). Ascites is a common complication of cirrhosis decompensation. Approximately 50% of patients with compensated cirrhosis develop ascites within a period of 10 years (5). The emergence of ascites predicts a poor prognosis of decompensated cirrhosis, with a mortality of 15% after 1 year and 44% at the 2 year follow-up. (6). In addition, the quality of life of patients with cirrhosis decreases following the formation of ascites and the 5-year survival rate drops to 50% (7). When ascites progress to refractory ascites, if a liver transplant is not conducted, the prognosis worsens and the 2-year survival rate falls to 35-50% (8). Treatment of ascites not only improves the quality of life of patients, but also reduces the risk of progression to spontaneous bacterial peritonitis, which is the most common fatal complication of liver cirrhosis (9). An improved understanding of the pathophysiological mechanism for ascites in patients with liver cirrhosis is necessary to improve patient treatment and to assist the use of targeted therapies.Ascites formation is the result of the combined action of many factors; however, the mechanism underlying the formation of cirrhoti...

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Cerebral Hemodynamics and Cognitive Function in Cirrhotic Patients with Hepatic Encephalopathy

Cited by 9 publications

References 45 publications

Astrocyte Pathophysiology in Liver Disease

Astrocyte Pathophysiology in Liver Disease

Study of the sleep quality and psychological state of patients with hepatitis B liver cirrhosis

Clinical value of urinary retinol‑binding protein in ascites due to cirrhosis

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