Nomiyama K, Tsuji H, Ikeda K, Kawatoko T, Murai K, Sadoshima S, Fujishima M, Ichiya Y
Second Department of Internal Medicine, Faculty of Medicine, Kyushu University, Fukuoka.
Fukuoka Igaku Zasshi. 1991 Oct;82(10):521-7.
A 56 year-old-male liver cirrhosis patient was admitted because of hepatic encephalopathy with hyperammonemia. We measured cerebral blood flow (CBF), cerebral oxygen extraction fraction (OEF) and cerebral metabolic rate for oxygen (CMRO2) by using PET before and after treatment of hyperammonemia. At the time of the first PET, serum ammonia was 152 micrograms/dl and on the second PET it was 88 micrograms/dl. The electroencephalogram and number connection test also improved on the second PET. CBF and CMRO2 were decreased by 25-42% in comparison to normal control and OEF increased 1-24% at first examination. Similar abnormal reduction of both CBF and CMRO2 and increase of OEF were seen at second examination. Reduced CBF and CMRO2 regardless of serum ammonia level suggests that heptic encephalopathy may be, at least in part, associated with pathological changes in brain tissue induced by hepatic metabolic disorder.
一名56岁男性肝硬化患者因肝性脑病伴高氨血症入院。我们在高氨血症治疗前后使用正电子发射断层扫描（PET）测量了脑血流量（CBF）、脑氧摄取分数（OEF）和脑氧代谢率（CMRO2）。第一次PET检查时，血清氨为152微克/分升，第二次PET检查时为88微克/分升。第二次PET检查时脑电图和数字连接试验也有所改善。与正常对照组相比，第一次检查时CBF和CMRO2降低了25 - 42%，OEF升高了1 - 24%。第二次检查时也出现了CBF和CMRO2类似的异常降低以及OEF升高。无论血清氨水平如何，CBF和CMRO2降低表明肝性脑病可能至少部分与肝脏代谢紊乱引起的脑组织病理变化有关。
