肝性脊髓病47例临床特点研究

The Clinical Characteristics Research of 47 Cases of Hepatic Myelopathy

目的：研究肝性脊髓病的临床特征、治疗及预后。方法：对我国2008年1月-2013年1月国内公开发表的病例报告进行回顾分析。结果：共检索到有效病例报告36篇，病例47例，其中男44例（93.62%），女3例（6.38%），年龄17~69岁。病因中前三位是乙肝肝硬化、酒精性肝硬化和丙肝肝硬化，分别有32例（68.08%）、4例（8.51%）和3例（6.38%）。经治疗后治愈1例（2.13%）、好转10例（21.28%）、无效21例（44.68%）、加重7例（14.89%）、死亡6例（12.76%）、未说明2例（4.26%）。结论：肝性脊髓病主要好发于男性，病因中绝大多数为肝硬化，其中以乙肝肝硬化为主，其次为酒精性肝硬化、丙肝肝硬化。临床表现为慢性进行性双下肢痉挛性瘫痪，内科治疗效果欠佳，肝移植为该病的最佳选择，本病多数预后不良，最终导致截瘫甚至死亡。

Objective： To explore the clinical characteristics, treatment and prognosis of hepatic myelopathy （HM）.Method： The domestic cases of HM published from January of 2008 to January of 2013 in our country were retrospectively analyzed.Result： A total of 36 effective case reports and 47 cases were found, of whom 44 cases （93.62%） were men and 3 cases （6.38%） were women. The age of them was from 17 to 69.The cause of the top three respectively were hepatitis B cirrhosis, alcoholic cirrhosis of liver and hepatitis C cirrhosis of the liver. The cases of them were 32 cases （68.08%）, 4 cases （8.51%） and 3 cases （6.38%）. After treatment 1 cases （2.13%） were cured, improved 10 cases （21.28%）, and not improved 21 cases （44.68%）, 7 cases （14.89%） aggravated, 6 cases （12.76%） died, and 2 cases （4.26%） did not explain.Conclusion： Hepatic myelopathy mainly occurs in men, and hepatitis B cirrhosis is the main reason, followed by alcoholic liver cirrhosis and hepatitis C cirrhosis of the liver. The clinical manifestations of HM is chronic progressive spastic paraparesis. The medical treatment has poor effect. Liver transplantation is the best choice for the disease, most patients have poor prognosis. HM eventually result in paraplegia and even death.