本文選題：肝性脊髓病 + 肝硬化�。� 參考：《山西醫(yī)科大學》2014年碩士論文

【摘要】：研究目的： 根據(jù)目前國內(nèi)肝性脊髓�。╤epatic myelopathy，HM）的研究現(xiàn)狀，通過分析近5年來國內(nèi)較大樣本的該病患者的臨床特點來歸納總結(jié)肝性脊髓病的臨床特征、最新病理生理研究進展、治療現(xiàn)狀及預后，使我們對該病有進一步的認識，降低誤診漏診率，并尋找目前該病的爭議點及新的有效的治療方法。 研究方法： 收集我國自2008年1月至2013年1月國內(nèi)公開發(fā)表的病例報告，對這些病例報告進行歸類整理分析，最后總結(jié)出肝性脊髓病的臨床特點，同時找出目前該病爭議點及新的治療方法。 研究結(jié)果： 共檢索到有效病例報告52篇，病例84例，其中男性77例（91.67%），女性7例（8.33%），年齡17-69歲。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%），經(jīng)內(nèi)科治療后好轉(zhuǎn)15例（20.27%），無效31例（41.89%），加重12例（16.22%），死亡11例（14.86%），未說明5例（6.76%）；肝移植10例，好轉(zhuǎn)8例。 研究結(jié)論： 肝性脊髓病主要好發(fā)于男性，病因中絕大多數(shù)為肝硬化，其中國內(nèi)以乙肝肝硬化為主。發(fā)病機制仍不清楚，除了氨的毒性、神經(jīng)營養(yǎng)缺乏及脊髓細胞免疫損傷等外，還有血流動力學因素及錳的毒性等。HM臨床表現(xiàn)為慢性進行性雙下肢痙攣性癱瘓。病理生理改變?yōu)槠べ|(zhì)脊髓束的髓鞘脫失和軸突變性，還有大腦皮層出現(xiàn)Alzheimer Ⅱ型細胞和海綿狀變性，其診斷無統(tǒng)一的金標準，需除外其它導致脊髓損害的疾病。內(nèi)科治療無明顯作用，肝移植是目前比較認可的有效治療方法，目前報道有效的治療方法還有血漿置換聯(lián)合灌流、胎兒肝干細胞移植、血管內(nèi)介入治療及中醫(yī)療法等。本病多數(shù)預后不良，最終導致截癱甚至死亡。
[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，

本文編號：2033185