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Cerebral blood flow and plasma free tryptophan in cirrhotics with and without hepatic encephalopathy

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Abstract

Cerebral blood flow (CBF), measured by the non-invasive 133-Xenon inhalation method, plasma levels of ammonia (NH3) and free tryptophan (fTRP) were determined in 30 cirrhotic patients without overt encephalopathy. Psychometric evaluation detected subclinical hepatic encephalopathy (SHE) in 20 of them, and was normal in the other 10. A significant CBF difference (p<0.05) was found between the SHE and the non-SHE patients.

fTRP levels were significantly (p<0.05) higher in patients with SHE than in those without SHE, and a significant negative correlation (p=0.003) was found between CBF values and fTRP in the whole group of patients. NH3 did not differ in the two subgroups and did not correlate with CBF values.

It is concluded that CBF could have some implications in SHE, although its relevance is still unclear. The negative correlation between CBF and fTRP prompts further investigation concerning the relationships between plasma fTRP, brain serotonin, cerebral metabolism and blood flow in the development of brain derangement during cirrhosis.

Sommario

Abbiamo determinato il Flusso Ematico Cerebrale (CBF), tramite la metodica inalatoria non invasiva allo Xenon-133, i livelli plasmatici di Ammonio (NH3) e del Triptofano libero (fTRP) in 30 pazienti cirrotici senza encefalopatia conclamata. La valutazione psicometrica rivelò un'Encefalopatia Epatica Subclinica (SHE) in 20 di loro, mentre negli altri 10 era nei limiti della norma.

Una differenza significativa (p<0.05) dei valori di CBF fu riscontrata tra i pazienti con SHE e quelli senza SHE.

I livelli di fTRP erano significativamente più elevati (p<0.05) nei pazienti con SHE rispetto a quelli senza SHE e una correlazione negative statisticamente significativa (p=0.003) fu trovata tra i valori di CBF e quelli di fTRP nell'intero gruppo dei pazienti. I livelli di NH3 non differivano nei due sottogruppi e non correlavano con i valori di CBF.

Si conclude che la SHE potrebbe avere un ruolo nella riduzione del CBF osservata in alcuni pazienti, anche se il suo ruolo preciso non è ancora chiarito. Ulteriori ricerche sono necessarie per chiarire le interazioni tra il CBF, il fTRP ed i sistemi neurotrasmettitoriali serotoninergici nella genesi della compromissione encefalica in corso di cirrosi epatica.

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Authors and Affiliations

  1. Cattedra di Gastroenterologia, Università di Genova, V.le Benedetto XV,6, 16132, Genova

    Testa R., Grasso A. & Celle G.

  2. Cattedra di Neurofisiopatologia dell'Università e Centro di Studio per la Neurofisiologia Cerebrale (C.N.R.), Genova

    Rodriguez G., Arvigo F., Gris A., Nobili F., Marenco S. & Rosadini G.

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  1. Testa R.
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  2. Rodriguez G.
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Testa, R., Rodriguez, G., Arvigo, F. et al. Cerebral blood flow and plasma free tryptophan in cirrhotics with and without hepatic encephalopathy. Ital J Neuro Sci 10, 415–421 (1989). https://doi.org/10.1007/BF02334946

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