摘要
目的分析10例肝性脊髓病(HM)患者的临床特点,进一步探讨其发病机制和影像学特点。方法对10例诊断为肝性脊髓病患者的临床资料进行回顾性总结。结果本研究10例患者中乙型肝炎肝硬化者8例(80%)、丙型肝炎肝硬化者2例(20%)。10例患者均行门体静脉分流(自然分流者9例、手术分流者1例),自然分流患者以食管胃底静脉曲张为主(88.9%)。1例(10%)患者头颅MRI显示T2相双侧基底节区对称分布的斑片状异常高信号。10例患者均表现为双下肢肌力下降、肌张力增高、腱反射亢进,9例病理征阳性(90%),2例双下肢感觉障碍(20%)。10例患者经过1个月治疗,肝功能指标(ALB、TBil)较治疗前好转(t=-2.60,P=0.02和t=2.29,P=0.03),血氨水平下降(t=2.55,P=0.02),但脊髓病变情况并未缓解。结论 HM患者头颅MRI双侧基底节区对称性病变,可能由于脊髓病变沿皮质脊髓侧束向远端逆行发展,累及皮层基底节区。本研究2例患者深浅感染障碍考虑可能长期的门静脉高压,致胸、腰段椎静脉丛淤血,导致与下肢运动相关的脊髓侧索和后索损害有关。
Objective To hepatic myelopathy （HM）. Methods explore more details about the pathogenesis and imaging features of Ten patients with HM were enrolled in this study. The clinical data were investigated, retrospectively. Results There were eight cases with hepatitis B and two cases with hepatitis C among the ten cases with liver cirrhosis and HM. Among the ten cases of portal systemic shunt, nine cases were naturally formed shunt and one case was with operation. Esophageal-gastro varices consisted of 88.9% in naturally formed shunt. Head MRI findings revealed symmetrical lesions were in bilateral basal ganglia in one HM case with operation. In ten cases with HM, the muscle force of both lower limbs declined, muscle tension increased and tendon hyperreflexia. Nine cases were found pathological sign positive and two cases with sensory disturbance. After one month treatment, liver function indicators （ALB, TBil） of all the patients improved （t = -2.60, P = 0.02; t = 2.i9, P = 0.03） and blood ammonia decreasd （t = 2.55, P = 0.02）, but symptoms of HM could not be improved. Conclusions In head MRI, bilateral basal ganglia showed symmetrical lesions, which was most likely regressive along the lateral corticospinal tract to distal end, probably involving the basal area of cortex. Two cases of HM in the study had superficial and deep paresthesia. As a result of long-term portal hypertension,the congestion of venous plexus in thoracolumbar vertebral caused chronic ischemia and hypoxia, and eventually the funiculus lateralis and posterior funiculus in spinal cord were damaged.
出处
《中华实验和临床感染病杂志（电子版）》
CAS
2013年第2期96-100,共5页
Chinese Journal of Experimental and Clinical Infectious Diseases(Electronic Edition)
