摘要
目的探讨肝性脊髓病(HM)的临床特点、治疗及不同血氨水平HM患者的转归情况。方法回顾性分析2013年1月至2019年10月郑州大学第一附属医院收治的49例HM患者的临床特点、治疗及预后。根据入院时血氨水平将其分为3组,比较不同分组患者肌力、疾病严重程度及预后。结果49例HM患者中男44例,女5例,平均年龄(50.5±9.0)岁。49例患者均出现肝硬化失代偿期症状及不同程度的下肢痉挛性瘫痪,12例患者下肢深浅感觉异常,7例患者大小便异常。单纯内科治疗39例,肝移植4例,血管介入治疗5例,1例接受糖皮质激素治疗。肝功能改善42例,肌力改善9例。3组患者肌力、疾病严重程度以及肌力预后、肝功能预后比较,差异无统计学意义(P>0.05)。结论HM主要发生于慢性肝病终末期,以进行性双下肢痉挛性瘫痪为主要临床表现,与手术继发或自发门体分流相关。不同血氨水平HM患者的肌力、疾病严重程度及预后无差异,提示血氨水平与HM严重程度和预后无关。
Objective To study the clinical characteristics,treatments and outcomes of patients with hepatic myelopathy(HM)with different blood ammonia levels.Methods The clinical characteristics,treatments and outcomes of 49 cases of HM admitted to the First Affiliated Hospital of Zhengzhou University from January 2013 to October 2019 were retrospectively analyzed.The patients were divided into three groups according to blood ammonia levels at admission.The muscle strengths,severities of disease and outcomes among the three groups were compared.Results There were 44 males and 5 females in 49 patients with HM,and the average age was(50.5±9.0)years old.All the patients appeared spastic paralysis of lower extremity in different degrees,who were in the stage of liver cirrhosis decompensation.Deep and shallow paresthesia occurred in 12 patients,and 7 patients had sphincter involvement.Thirty-nine patients were treated with only medical therapy,and 3 patients underwent liver transplantation,and 5 patients underwent vascular interventional therapy,and 1 patient was treated with glucocorticoid.Liver function improved in 42 patients and muscle strength improved in 9 patients.There were no statistical differences in the muscle strength,severity of disease,prognosis of muscle strength and liver function among the three groups(P>0.05).Conclusion HM mainly occurs in the end-stage of chronic liver disease,with progressive spastic paralysis of lower extremity as the main clinical manifestation,which is related to secondary or spontaneous portosystemic shunt.There are no statistical differences in the muscle strength,severity of disease,prognosis among patients with HM with different blood ammonia levels,indicating that blood ammonia level is not related to the severity and prognosis of HM.
作者
郭小芳
张连峰
王春峰
GUO Xiaofang;ZHANG Lianfeng;WANG Chunfeng(Department of Gastroenterology,the First Affiliated Hospital of Zhengzhou University,Zhengzhou 450000,China)
出处
《河南医学研究》
CAS
2021年第1期12-16,共5页
Henan Medical Research
关键词
肝性脊髓病
肝硬化
门体分流
血氨
hepatic myelopathy
hepatic cirrhosis
portosystemic shunt
blood ammonia
