尿毒症脑病的临床及影像学特征  

The clinical and imaging features in uremic encephalopathy

作　　者：路华[1] 宋赤[1] 李洪哲[1] 许维亮[1] 陈济德[1] 

机构地区：[1]铁道部济南铁路中心医院神经科

出　　处：《中国危重病急救医学》1999年第4期220-222,共3页Chinese Critical Care Medicine

摘　　要：目的：观察尿毒症脑病（ＵＥ）的临床表现特点，探讨痫性抽搐（ＥＴ）与颅脑影像学异常结果的关系。方法：①对４１例尿毒症脑病患者进行颅脑ＣＴ或磁共振（ＭＲ）扫描并与同期４１例其他原因做颅脑ＣＴ的患者作比较。②对ＣＲＦ模型大鼠进行脑组织病理检查。结果：①尿毒症脑病患者均有多种不同程度的神经系统异常表现。②异常脑部影像学表现为：４１例中３５例次显示脑萎缩，１７例次有低密度病灶，１０例次为髓质病变；对照组分别是９例次、１例次和１例次，２组有显著性差异。③ＣＲＦ大鼠脑组织光镜检查发现，大脑皮质中可见散在的神经细胞坏死灶，小血管管壁增厚，血管减少，颞叶海马ＣＡ１区锥体细胞变性、坏死明显。结论：所有尿毒症患者均有不同程度的中枢神经系统损害的临床表现；动物实验提供的病理学结果及影像学检查显示的脑萎缩和低密度病灶是产生上述高级精神活动异常的重要原因。Objective:To observe the clinical features in uremic encephalopathy (UE) and investigate the relationship among the epileptic twitch (ET),the representation of CT or MR examination.Methods:From 1996 to the end of 1997,41 cases with uremia were included in the present study,and 41 cases without uremia served as controls.Brain CT or MR was examined in all cases.Also,pathologic examination of the brain was performed in rats subjected to real failure.Results:All 41 patients with uremia showed clinical symptoms of neurologic abnormality.Among the 41 cases,abnormal imaging performance of the brain was as follows:35 cases with brain atrophy,17 cases with lowdensity focus,and 10 cases with medullary lesion.However,in the control group brain atrophy,lowdensity focus,and medullary lesion were observed in 9,1,and 1 cases,respectively,and the difference was significant between patients with and without uremia.On the other hand,the microscope examinations of rat brains revealed focus of necrotic nerve cells scattered in the cerebral cortex,thickening of small vessel wall,and reduction in the number of the blood vessels.In addition,degeneration and necrosis of pyramidal nerve cells were found in the CA1 region of hippocampus in the temporal lobe.Conclusions:All the cases with uremia have the performance of central nervous systemic lesions.Brain atrophy and lowdensity focus may be of importance in the development of central nervous system dysfunction.

关 键 词：尿毒症脑病 痫性抽搐 海马CA1区 脑萎缩 

分 类 号：R695.06[医药卫生—泌尿科学] R747.9[医药卫生—外科学]