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肝性脑病. hepatic encephalopathy. 佳木斯大学基础 医学院病理生理教研室 王淑秋. 本章重点内容. 肝性脑病. 概念 :继发于严重肝病的神经精神综合症 举例:. 发生机制或学说. 氨中毒学说. 假性神经递质学说. 血浆氨基酸失衡学说. 神经递质. 肝性脑病. GABA 学说. 目前新观点. 高血氨. 神经递质. 轻微性格、行为改变. 睡眠障碍 行为失常. 扑翼样震颤 Flapping tremor (aste‘rixis). 昏 睡、精 神 错 乱. 肝性昏迷 (hepatic coma). NH3. NH3.

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肝性脑病

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hepatic encephalopathy


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GABA


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Flapping tremor (asterixis)


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Hepatic coma

(hepatic coma)


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NH3

NH3

NH3

--

---

--

ATP

NH3K+Na/K


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6-

NAD

NADH

A

+

ATP

NAD

NADH

-

-

NADH

+NH3

NAD

+NH3

ATP

1.

-

-

NADH

ATP


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NH3

NH3

NH3

--

---

--

ATP

NH3K+Na/K


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1.

6-

NAD

NADH

A

-

+

ATP

NAD

NADH

-

-

NADH

+NH3

NAD

+NH3

ATP


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NH3

NH3

NH3

--

---

--

ATP

NH3K+Na/K


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3.:

Na+-K+ATP

Na+

NH3

K+

NH3

K+

K+

- _ -

K+

,|Em| |Em-Et|

,Em


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-

1970

HO

CHOHCH2NH3

CHOHCH2NH3

HO

+AA


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CHOHCH2NH2

HO

CHOHCH2NH2

HO

phenylethanolamine

noradrenaline

HO

CHCH2NH2

CHOHCH2NH2

HO

HO

octopamine

dopamine


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Hepatic failure

Nomal


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2.


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/0.6-1.23-3.5

AA--AA

--AAAA

AA--AA

/--

AA-

1.

2.BCAA

AA

AA


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BCAA

BCAA/AAA

AAA

/

AAA


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-

1980GABAGABA

GABA

GABA

*GABAGABA

*Cl-N


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Cl-

Cl-

Cl-

GABA

Cl-


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AA--5-HT--

----AAA

St

INS--BCAA--BCAA

GABA

-

GABA


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hepatorenal syndromeHRS


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HRS


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GFR


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PGE2 TXA2

--

GFR


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-


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