【摘要】：肝性腦病(hepatic encephalopathy,HE)是一個復雜的神經(jīng)精神綜合征,臨床上表現(xiàn)為認知、行為和機能障礙,其與肝衰竭和或門體靜脈分流有關(guān),主要表現(xiàn)為意識障礙、行為失常和昏迷。HE是急性和慢性肝臟疾病嚴重、致死的并發(fā)癥,如不及時糾正,甚至會危及生命。肝性腦病的發(fā)病機制目前公認的是氨中毒學說,血氨的生成及代謝決定肝性腦病的病情進展,治療上主要是解除HE誘因及降血氨等治療來達到臨床上的治愈。根據(jù)患者精神狀況、臨床指標和一般的意識狀態(tài)的改變,將HE分為0-4期五個時期(west Haven分期),即從輕微的精神改變到深昏迷,其中0期即為MHE,MHE指肝硬化患者在臨床檢查沒有異常,但出現(xiàn)神經(jīng)心理學和神經(jīng)生理學損傷,若MHE不及時干預(yù)和治療,最終有可能發(fā)展為OHE。臨床上OHE通過癥狀、體征及血氨等實驗室檢查診斷并不難,MHE因無神經(jīng)系統(tǒng)臨床表現(xiàn)易漏診、誤診。MHE目前還沒有一個統(tǒng)一的診斷標準,臨床上需要敏感性高、特異性強的診斷HE方法,MHE由于缺乏典型的臨床表現(xiàn),只能通過神經(jīng)生理測驗和神經(jīng)心理測試發(fā)現(xiàn),但會受到年齡、教育程度、學習記憶和不同文化背景、種族及病人合作的影響,不宜單獨作為MHE的篩選手段。為了解決這些缺點,Van der Rijt等人提出了腦電圖光譜分析,并率先指出光譜分析可作為HE的診斷和預(yù)后的指標,因為腦電圖不受復雜的教育和文化影響,不受心理評估和病人合作與否的影響,腦電圖已被證明是敏感的、獨立的HE監(jiān)測工具。目的:探討輕型肝性腦病患者腦電圖檢查的臨床價值。材料和方法:對41例輕型肝性腦病患者進行腦電圖檢查,觀察腦電圖V監(jiān)測HE敏感性及特異性。將41例輕型肝性腦病患者按肝功能Child-pugh分級分為A、B、C 3組;并按有無肝性腦病典型的臨床體征分為2組;按臨床相關(guān)指標分為5組,分別與相應(yīng)EEG進行統(tǒng)計分析。結(jié)果:(1)輕型肝性腦病的病因中,肝硬化有36例,占87.80%;(2)41例輕型肝性腦病患者的EEG輕微異常有9例(21.95%),輕度異常有27例(65.85%),中度異常有5例(12.20%);(3)41例輕型肝性腦病患者按肝功能Child-pugh分級分為A、B、C三組,A組8例、B組12例、C組21例,B組與C組差異無顯著性,A組與B組、C組之間有顯著性差異;(4)AST/ALT比值≥1.2組與1.2組比較腦電圖異常差異無顯著性;總膽紅素≤34.2組與34.2組比較腦電圖異常差異無顯著性;白蛋白30組與≤30組比較腦電圖異常差異有顯著性,其中輕微腦電圖異常與輕度腦電圖異常差異有顯著性;(5)PTA80組與≤80組、PTA40組與≤40組比較腦電圖異常差異均無顯著性;(6)血氨≥60組與60組比較腦電圖異常差異無顯著性;血氨≥120組與120組比較腦電圖異常差異無顯著性;(7)有HE臨床體征組與無HE臨床體征組差異有顯著性,其中輕微HE與輕型HE比較腦電圖異常差異有顯著性。結(jié)論:(1)輕微肝性腦病可出現(xiàn)輕微異常腦電圖波;(2)腦電圖異常程度與肝性腦病分級呈正相關(guān);(3)腦電圖檢查具有實用性強,操作簡便等特點,可以作為輕型肝性腦病的臨床診斷工具,可以更廣泛應(yīng)用于臨床,提高對輕型肝性腦病尤其是輕微肝性腦病的診斷率。
[Abstract]:Hepatic encephalopathy (HE) is a complex neuropsychiatric syndrome. It is characterized by cognition, behavior and dysfunction. It is associated with liver failure and portosystemic shunt. The main manifestations are disturbance of consciousness, abnormal behavior, and coma.HE, which are acute and slow liver diseases, and are fatal complications, such as untimely correction, The pathogenesis of hepatic encephalopathy is currently recognized as ammonia poisoning theory, the formation and metabolism of blood ammonia determine the progression of hepatic encephalopathy, the treatment is mainly to relieve the HE inducement and blood ammonia treatment to achieve clinical cure. According to the patient's mental condition, clinical index and general consciousness change, HE It is divided into 0-4 stages, five periods (West Haven staging), from mild mental change to deep coma, of which 0 is MHE, and MHE refers to cirrhosis patients with no abnormal clinical examination, but neuropsychological and neurophysiological injuries occur. If MHE does not intervene and treat in time, it may eventually develop into OHE. clinical OHE through symptoms, signs and blood. Laboratory diagnosis of ammonia, such as MHE, is not difficult to diagnose. The misdiagnosis of the clinical manifestations of the nervous system is easy to be missed. The misdiagnosed.MHE has not yet a unified diagnostic standard. The diagnostic HE method with high sensitivity and specificity is needed in clinic. Because of the lack of typical clinical manifestations, MHE can only be found by the psychologic test and neuropsychological test. Age, education, learning, memory, and different cultural backgrounds, the influence of race and patient cooperation should not be used alone as a screening tool for MHE. In order to solve these shortcomings, Van der Rijt et al. Proposed the electroencephalogram spectrum analysis, and took the lead to point out that spectral analysis can be used as an indicator of the diagnosis and prognosis of HE because the electroencephalogram is not subject to complex education. The electroencephalogram has been proved to be a sensitive and independent HE monitoring tool. Objective: To explore the clinical value of electroencephalogram in patients with light hepatic encephalopathy. Objective: To explore the clinical value of electroencephalogram examination in patients with light hepatic encephalopathy. Materials and methods: electroencephalogram examination was carried out in 41 patients with light hepatic encephalopathy, and the sensitivity of electroencephalogram V was observed and the sensitivity of HE was observed and the sensitivity of electroencephalogram was observed. Specificity. 41 cases of light hepatic encephalopathy were divided into A, B, and 3 groups according to the liver function Child-pugh classification, and divided into 2 groups according to the typical clinical signs of hepatic encephalopathy, and divided into 5 groups according to the clinical related indexes. Results: (1) there were 36 cases of liver cirrhosis, 87.80%, and 41 cases of light liver disease. (2) 41 cases of light liver. The mild abnormality of EEG in patients with sexual encephalopathy was 9 (21.95%), mild abnormality in 27 cases (65.85%), moderate abnormality in 5 cases (12.20%); (3) 41 cases of light hepatic encephalopathy were divided into A, B, C three, group A, 8 cases, B group 12, C group 21, there was no significant difference between B group and C group, A group and B group, significant difference; 4) ratio There was no significant difference in electroencephalogram abnormalities between the 1.2 groups and the 1.2 groups; the total bilirubin less than 34.2 groups and the 34.2 groups had no significant difference in electroencephalogram. The differences of abnormal EEG differences between the 30 groups and the 30 groups were significant, and the difference between the mild electroencephalogram and the mild electroencephalogram was significant; (5) group PTA80 and < 80, group PTA40 There was no significant difference in electroencephalogram abnormalities between the 40 groups and the 40 groups. (6) there was no significant difference in electroencephalogram abnormalities between the group of blood ammonia > 60 and the 60 groups. There was no significant difference in electroencephalogram abnormalities between the groups of blood ammonia 120 and the 120 groups. (7) there was a significant difference between the HE clinical sign group and the non HE clinical sign group, in which the slight HE and the light HE were compared to the abnormal electroencephalogram. Conclusion: (1) slight abnormal EEG can be found in mild hepatic encephalopathy; (2) the abnormal degree of electroencephalogram is positively correlated with the classification of hepatic encephalopathy; (3) the electroencephalogram examination is practical and easy to operate. It can be used as a diagnostic tool for light hepatic encephalopathy, and can be more widely used in clinic to improve the light liver nature. The diagnostic rate of encephalopathy, especially for mild hepatic encephalopathy.
【學位授予單位】：吉林大學
【學位級別】：碩士
【學位授予年份】：2016
【分類號】：R575.3

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