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目的 探讨不同类型慢性肝性脑病的临床特征及与脑电图 (EEG)、头颅MRI及肝脏功能之间的关系。方法 对 8例获得性慢性肝性脑病诊疗过程进行回顾性分析。结果 8例病人中只有 1例肝酶明显升高 ,2例正常 ,5例轻度升高。出现神经精神症状时 ,除以锥体外系症状为突出表现的 1例病人外 ,EEG均示弥散减慢活动伴有三相波 ,且与临床波动及血氨 (NH3 )水平相平行。 2例接受MRI检查的病人均示底节区长T1、长T2 信号。 1例尸检示双壳核弧形软化 ,光镜下可见AlzheimerⅡ型细胞。结论 缺乏神经系统局灶体征的原因不明的进行性或间歇性神经精神异常 ,如EEG显示弥散性减慢活动伴有三相波 ,且与临床症状波动、血氨 (NH3 )水平相平行 ,尽管肝酶升高不明显 ,也应高度警惕慢性肝性脑病的存在。若MRI显示底节区病变 ,更高度提示慢性肝性脑病。
Objective To investigate the clinical characteristics of different types of chronic hepatic encephalopathy and its relationship with electroencephalogram (EEG), cranial MRI and liver function. Methods Eight cases of acquired chronic hepatic encephalopathy were retrospectively analyzed. Results Only one of the 8 patients had a marked increase in liver enzymes, two were normal, and five were slightly elevated. In the presence of neuropsychiatric symptoms, EEG showed diffuse slowing activity accompanied by three-phase waves, in addition to extrapolation of extra-caudal symptoms, and was parallel to clinical fluctuations and blood ammonia (NH3) levels. Two cases of patients undergoing MRI examination showed long T1, long T2 signal of ganglia. One case of autopsy showed bimodal nucleus arc softening, visible Alzheimer Ⅱ cells under light microscope. Conclusions The lack of progressive or intermittent neuropsychiatric anomalies with unknown causes of focal neurological signs such as EEG showed a three-phase wave associated with diffuse slowing activity and parallel with clinical symptoms and NH3 levels, Enzyme is not obvious, should also be highly vigilant of the existence of chronic hepatic encephalopathy. If MRI shows lesions in the basal ganglia, it is highly suggestive of chronic hepatic encephalopathy.