CAJ | 학술논문

目的：探讨发作性肝性脑病的误诊原因，提高对该病的认识。方法对我院近年来初诊误诊10例发作性肝性脑病患者的临床资料进行回顾性分析。结果10例患者均有发作性神经精神症状体征，慢性肝病的病史和临床表现不明显；疾病发作时血氨明显增高，转氨酶和胆红素正常或仅轻度增高；脑电图显示弥散性高波幅慢波，有的伴三相波或痫样放电；6例头颅MRI显示基底节对称性长T1，长T2信号；初诊误诊为缺血性脑血管病7例，心因性精神障碍2例，精神运动型发作癫痫1例。结论注意发作性肝性脑病的临床特点，重视血氨、脑电图及MRI的诊断价值，是减少和避免该病误诊的主要途径。
목적：탐토발작성간성뇌병적오진원인，제고대해병적인식。방법대아원근년래초진오진10례발작성간성뇌병환자적림상자료진행회고성분석。결과10례환자균유발작성신경정신증상체정，만성간병적병사화림상표현불명현；질병발작시혈안명현증고，전안매화담홍소정상혹부경도증고；뇌전도현시미산성고파폭만파，유적반삼상파혹간양방전；6례두로MRI현시기저절대칭성장T1，장T2신호；초진오진위결혈성뇌혈관병7례，심인성정신장애2례，정신운동형발작전간1례。결론주의발작성간성뇌병적림상특점，중시혈안、뇌전도급MRI적진단개치，시감소화피면해병오진적주요도경。
ObjectiveTo probe clinical features of attacked hepatic encephalopathy,enhance recognize on about problem with the disease.MethodsClinical data of 10 patients with attacked hepatic encephalopathy were analysed retrospectively. ResultsThe patients all have attacked symptom and sign of nervous mental,not have obvious history and clinical manifestation of chronic hepatic disease. The level of serum ammmonia during the disease attacked was elevated remarkably,transaminase and bilirubin was normal or elevated slightly.The EEG showed diffusely slowing wavers,some at the same time showed triphasic waves or epileptiform discharge. The cranial MRI showed symmetric hypointence in T1 weighted imagrs,hyperintence in T2 weighted images on basal ganglia for 6 case of the 10patients. There are misdiagnosis on first diagnosis,which are 7case with ischemic cerevascular diseases,2 case with psychogenic mental disorder,1 case with psychomotor seizure.ConclusionsThe chief way for reduce and avoid misdiagnosis are pay attention to clinical characteristic of attacked hepatic encephalopathy,attach importance to diagnose value of serum ammonia,EEG and MRI.