摘要
目的探讨肝性脊髓病(hepatic myelopathy,HM)的临床特征、误诊原因及防范措施。方法回顾性分析2009年11月-2019年6月西京医院收治的24例HM患者的临床资料,并复习相关文献。结果24例患者均有肝硬化病史,临床表现为双下肢肌力减低,部分实验室检查和影像学检查异常。目前HM尚无统一的诊断标准,根据患者病史、临床特征、实验室检查及影像学检查结果,结合多篇文献和专家意见明确诊断。确诊后1例患者行肝移植治疗,所有患者均给予对症治疗和康复锻炼。出院时3例患者改良RANKIN量表(Modified Rankin Scale,mRS)评分改善。出院后随访3 m,6例患者mRS评分改善。预后与病程有一定相关性。结论HM的发病率低,临床表现缺乏特异性。详细询问病史、仔细查体并及时行肝功能功能和腹部超声等检查有助于提高早期诊断率,改善患者的临床症状和预后。
Objective To explore the clinical features,causes of misdiagnosis and preventive measures of hepatic myelopathy(HM).Methods The clinical data of 24 cases of HM admitted to Xijing Hospital from November 2009 to June 2019 were analyzed retrospectively,and relevant literatures were reviewed.Results All the 24 patients had a history of cirrhosis,and the clinical manifestations were decreased muscle strength of both lower limbs.Laboratory and imaging examinations were abnormal in some patients.Currently,there is no unified diagnostic standard for HM.According to the patient’s history,clinical manifestations,laboratory examination and imaging examination results,combined with literatures and expert opinions,hepatic myelopathy was diagnosed.One patient was treated with liver transplantation,and all patients were given symptomatic treatment and rehabilitation exercise.Scores of Modified Rankin Scale(mRS)improved in 3 patients at discharge.Follow-up of 3 months after discharge showed scores of mRS improved in 6 patients.The prognosis may be correlated with the course of disease.Conclusion HM has a low incidence and the clinical manifestations lack specificity.Detailed medical history,careful physical examination,timely examination of liver function and abdominal ultrasound can help early diagnosis and improve the clinical symptoms and prognosis of patients.
作者
费笑非
胡萌萌
秦娜
吴文婷
李雯
FEI Xiaofei;HU Mengmeng;QIN Na(Department of Neurology,Xijing Hospital,The Fourth Military Medical University,Xi’an 710032,China)
出处
《中风与神经疾病杂志》
CAS
2021年第1期62-64,共3页
Journal of Apoplexy and Nervous Diseases
基金
西京医院助推计划项目(XJZT19MJ21)。
