国人肝性脊髓病临床特点分析

发布时间：2018-06-18 00:39

  本文选题：肝性脊髓病 + 肝硬化　； 参考：《山西医科大学》2014年硕士论文

【摘要】：研究目的： 根据目前国内肝性脊髓病（hepatic myelopathy，HM）的研究现状，通过分析近5年来国内较大样本的该病患者的临床特点来归纳总结肝性脊髓病的临床特征、最新病理生理研究进展、治疗现状及预后，使我们对该病有进一步的认识，降低误诊漏诊率，并寻找目前该病的争议点及新的有效的治疗方法。 研究方法： 收集我国自2008年1月至2013年1月国内公开发表的病例报告，对这些病例报告进行归类整理分析，最后总结出肝性脊髓病的临床特点，同时找出目前该病争议点及新的治疗方法。 研究结果： 共检索到有效病例报告52篇，病例84例，其中男性77例（91.67%），女性7例（8.33%），年龄17-69岁。病因中前三位是乙肝肝硬化57例（67.86%），酒精性肝硬化10例（11.91%）和丙肝肝硬化6例（7.14%），经内科治疗后好转15例（20.27%），无效31例（41.89%），加重12例（16.22%），死亡11例（14.86%），未说明5例（6.76%）；肝移植10例，好转8例。 研究结论： 肝性脊髓病主要好发于男性，病因中绝大多数为肝硬化，其中国内以乙肝肝硬化为主。发病机制仍不清楚，除了氨的毒性、神经营养缺乏及脊髓细胞免疫损伤等外，还有血流动力学因素及锰的毒性等。HM临床表现为慢性进行性双下肢痉挛性瘫痪。病理生理改变为皮质脊髓束的髓鞘脱失和轴突变性，还有大脑皮层出现Alzheimer Ⅱ型细胞和海绵状变性，其诊断无统一的金标准，需除外其它导致脊髓损害的疾病。内科治疗无明显作用，肝移植是目前比较认可的有效治疗方法，目前报道有效的治疗方法还有血浆置换联合灌流、胎儿肝干细胞移植、血管内介入治疗及中医疗法等。本病多数预后不良，最终导致截瘫甚至死亡。
[Abstract]:Objective: to summarize the clinical characteristics of hepatic myelopathy by analyzing the clinical characteristics of large sample of patients with hepatic myelopathy in recent 5 years according to the present research situation of hepatic myelopathy in China. The latest research progress in pathophysiology, treatment status and prognosis make us have a further understanding of the disease, reduce the rate of misdiagnosis and miss diagnosis, and search for the controversial points and new effective treatment methods of the disease at present. Methods: from January 2008 to January 2013, the case reports published in China were collected and analyzed, and the clinical characteristics of hepatic myelopathy were summarized. At the same time, to find out the current controversy and new treatment of the disease. Results: a total of 52 effective cases (84 cases) were found, of which 77 cases were male (91.67%) and 7 cases were female (8.33%), aged 17-69 years. The first three etiological factors were 57 cases of hepatitis B cirrhosis, 10 cases of alcoholic cirrhosis and 6 cases of cirrhosis of hepatitis C, 15 cases were improved after medical treatment, 31 cases had no effect, 12 cases had aggravation, 11 cases died, 11 cases died, 5 cases had no explanation, 10 cases had liver transplantation, 8 cases had improved. Conclusion: hepatic myelopathy mainly occurs in males, most of the etiology is cirrhosis, among which hepatitis B cirrhosis is the main cause in China. In addition to ammonia toxicity, neurotrophic deficiency and spinal cord cellular immune injury, there were hemodynamic factors and manganese toxicity. HM showed chronic progressive spastic paralysis of the lower extremities. The pathophysiological changes were myelin demyelination and axonal degeneration of the corticospinal tract, and Alzheimer 鈪，

本文编号：2033185