肝性脊髓病1例分析

Report and analysis of a case of hepatic myelopathy

肝性脊髓病是由慢性肝病引起的一种少见的神经系统并发症,有着多重复杂的发病机制,主要病理改变为脊髓侧束对称性脱髓鞘病变,以隐性起病、逐步进展的双下肢痉挛性截瘫、腱反射亢进及肌张力升高为临床特征。传统降血氨治疗对HM无效,早期肝脏移植可阻止其病程进展,明显改善神经功能。笔者报道1例肝硬化并发HM的病例,以提高临床医生对本病的认识,尽量做到早诊断、早治疗,最大可能地改善患者预后。

Hepatic myelopathy is a rare complication of chronic liver disease, usually associated with multiple pathogenesy,eausing insidious progressive spastic paraparesis,hyperreflexia and increased muscle tone. The pathology is known to mainly involve symmetrical demyelination of the lateral pyramidal tracts.Standard medical therapies for reducing ammonia production and absorption are not beneficial to HM,whereas a liver transplantation could prevent progression of spastic paraparesis and improve neurologic symtoms.particularly in the earlier clinical stage of the disorder. Here we described a cirrhotic patient with HM,promoting neurologist and hepatologists pay more awareness to this disorder and try their best to diagnose it earlierly and accurately,as well as treat it effectively.