氨苯乙醇胺.PPT

Hepatorenal syndrome 是指肝硬化患者在失代偿期所发生的功能性肾功能衰竭及重症肝炎所伴随的急性肾小管坏死 一、肝肾综合征的类型 (Classification of hepatorenal syndrome) (一) 肝性功能性肾衰竭 (Functional HRS) 患者肾脏无器质性病变，但肾血流量明显减少，肾小球滤过率降低，而肾小管功能正常。 (二)肝性器质性肾衰竭(Parenchymal HRS) 器质性肾衰竭的主要病理变化是肾小管坏死。主要与肠源性内毒素血症和大出血有关。 二、肝性功能性肾衰竭的发病机制 (Mechanisms of hepatic functional renal failure) 肝硬变患者在失代偿期发生的少尿是功能性的 Pathogenesis of HRS 肝硬化失代偿 肝功能障碍 门脉高压 腹水 胃肠道出血 血液淤积在 腹腔脏器 有效循环血量? 交感—肾上腺髓质系统? 肾素一血管紧张素系统? 内毒素血症 激肽释放酶 —激肽? PGE2? TXA2? LTs? 肾血管收缩 Renal perfusion，GFR? 肝肾综合征Functional renal failure 思 考 题 1．肝性脑病的基本概念？ 2．肝性脑病的主要发病机制？ 3．假性神经递质学说与血浆氨基酸失衡学说的联系和区别？ 4．肝性脑病的病因与诱因的区别？ 5．根据氨中毒等学说，可采用哪些方法治疗肝性脑病？ 6. 肝肾综合征概念和发病机制？ * Sleeping disorder 睡眠紊乱 Apathy 淡漠 Childishness 幼稚 Confusion 错乱 Drowsiness 嗜睡 Coma 昏迷 Flapping tremor 扑翼样震颤 * Subclinical HE No clinical symptom, no biochemical abnormality, diagnosed by mental test and electronic physiology * Standard therapy is acute administration of lactulose, its beneficial action is not fully understood. The use of oral antibiotics and BCAAs is of some benefit in patients who do not responded to lactulose. Limitation of protein in the diet may be useful in short periods, but is not recommended for a long time use. Future research will likely focus on the correction of alterations in neurotransmission. Abeu – Assi S. 2001 Brain stem reticular structure maintains consciousness through NT Cerebral cortex Interbrain Brain stem reticular structure Ascending nerve impulse Secondary Neuron NT Excitation of secondary neuron True NT synapse Excitation of secondary neuron FNT compete receptor Normal Hepatic failure 苯丙AA 酪AA 苯乙胺 酪胺 苯乙胺 酪胺 MAO ? 苯乙胺? 酪胺? 苯乙醇胺 羟苯乙醇胺 酪胺? 苯乙胺? False neurotransmitters CHOHCH2NH2 HO Octopamine