获得性慢性肝性脑病八例报告

Acquired chronic hepatic encephalopathy 8 cases report

目的 探讨不同类型慢性肝性脑病的临床特征及与脑电图 (EEG)、头颅MRI及肝脏功能之间的关系。方法 对 8例获得性慢性肝性脑病诊疗过程进行回顾性分析。结果 8例病人中只有 1例肝酶明显升高 ,2例正常 ,5例轻度升高。出现神经精神症状时 ,除以锥体外系症状为突出表现的 1例病人外 ,EEG均示弥散减慢活动伴有三相波 ,且与临床波动及血氨 (NH3 )水平相平行。 2例接受MRI检查的病人均示底节区长T1、长T2 信号。 1例尸检示双壳核弧形软化 ,光镜下可见AlzheimerⅡ型细胞。结论 缺乏神经系统局灶体征的原因不明的进行性或间歇性神经精神异常 ,如EEG显示弥散性减慢活动伴有三相波 ,且与临床症状波动、血氨 (NH3 )水平相平行 ,尽管肝酶升高不明显 ,也应高度警惕慢性肝性脑病的存在。若MRI显示底节区病变 ,更高度提示慢性肝性脑病。

Objective To probe the relationship between clinical features in acquired chronic hepatic encephalopathy (CHE) and the EEG, cranial MRI and laboratory findings of the liver funtion. Method Eight patiets with CHE were analysed retrospectively. Results The level of serum transaminase in 1 case of the 8 patients with CHE was elevated remarkably, slightly elevated in 5 cases, and normal in 2 cases. The EEG showed there appeared diffusely slowing activities and triphasic waves except in a patient with extrapyramidal symptoms. EEG changes were consistent with fluctuation of clinical symptoms and the level of serum ammonia. The cranial MRI cases showed a symmetric abnormal signal in basal ganglia, hyperintence in T 2 weighted images, hypointence in T 1 weighted images in 2 cases. Cerebral pathology in a dead patient showed symmetrically arc softening focus in basal ganglias and Alzheimer type Ⅱ astrocytes under the photomicroscope.Conclusion It should be especially regarded that when a CHE patient had progressive or intermittent disorders of neurological and mental state without local sign of nervous system, the EEG might show diffusely slowing activities and triphasic waves, and EEG changes might be consistent with fluctuation of clinical symptoms and the level of serum ammonia, though the level of serum transaminase did not elevate remarkably. CHE is highly suggested that the abnormality mentioned above should be accompanied symmetrically with abnormal signals of basal ganglia in MRI.