发作性肝性脑病10例误诊分析

The Analysis of 10 patients with attacked hepatic encephalopathy be misdiagnosis

目的探讨发作性肝性脑病的误诊原因,提高对该病的认识。方法对我院近年来初诊误诊10例发作性肝性脑病患者的临床资料进行回顾性分析。结果 10例患者均有发作性神经精神症状体征,慢性肝病的病史和临床表现不明显;疾病发作时血氨明显增高,转氨酶和胆红素正常或仅轻度增高;脑电图显示弥散性高波幅慢波,有的伴三相波或痫样放电;6例头颅MRI显示基底节对称性长T1,长T2信号;初诊误诊为缺血性脑血管病7例,心因性精神障碍2例,精神运动型发作癫痫1例。结论注意发作性肝性脑病的临床特点,重视血氨、脑电图及MRI的诊断价值,是减少和避免该病误诊的主要途径。

Objective To probe clinical features of attacked hepatic encephalopathy,enhance recognize on about problem with the disease. Methods Clinical data of 10 patients with attacked hepatic encephalopathy were analysed retrospectively.Results The patients all have attacked symptom and sign of nervous mental,not have obvious history and clinical manifestation of chronic hepatic disease. The level of serum ammmonia during the disease attacked was elevated remarkably,transaminase and bilirubin was normal or elevated slightly.The EEG showed diffusely slowing wavers,some at the same time showed triphasic waves or epileptiform discharge. The cranial MRI showed symmetric hypointence in T1 weighted imagrs,hyperintence in T2 weighted images on basal ganglia for 6 case of the 10 patients. There are misdiagnosis on first diagnosis,which are 7case with ischemic cerevascular diseases,2 case with psychogenic mental disorder,1 case with psychomotor seizure. Conclusions The chief way for reduce and avoid misdiagnosis are pay attention to clinical characteristic of attacked hepatic encephalopathy,attach importance to diagnose value of serum ammonia,EEG and MRI.