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1 临床资料 男性,44岁。双下肢无力,运动受限、僵硬4月余于1991年1月11日入院。患者1985年确诊为肝炎后肝硬变。1990年7月出现下肢浮肿,神志不清,血氨高,CT提示肝硬变,脾大,门脉高压。1月后症状加重,诊断肝性脑病,抢救后好转,仍感下肢无力、僵硬,步态不稳,转我院治疗。查体:神志清楚,面呈青铜色,未见肝掌及蜘蛛痣,巩膜轻度黄染,舌苔薄白有剥脱,心肺阴性,肝上界第4肋间,肋下约2cm,质中等,剑突下5cm;脾肋下3cm,质中等。有腹水,两下肢轻度浮肿。肌张力增强,肌力Ⅳ~+,腱反射亢进,触觉及温冷觉存在。踝阵挛阳性,Babinski征双侧阳性。实验室检查:
1 clinical data male, 44 years old. Both lower extremities weakness, limited exercise, stiffness in April more than January 1, 1991 admission. The patient was diagnosed with posthepatitic cirrhosis in 1985. July 1990 lower extremity edema, confusion, high blood ammonia, CT tips cirrhosis, splenomegaly, portal hypertension. 1 month later symptoms, diagnosis of hepatic encephalopathy, improvement after treatment, still feel weakness, stiffness, unstable gait, transfer to our hospital. Physical examination: conscious, the surface was bronze, no liver palms and spider nevus, scleral mild yellow dye, thin white tongue peeling, heart and lung negative, the upper boundary of the fourth intercostal space, ribs about 2cm, medium quality, Xiphoid 5cm; Spleen 3cm, medium quality. Ascites, two lower extremity edema. Muscle tension, muscle strength Ⅳ ~ +, tendon hyperreflexia, tactile and warm feeling there. Positive ankle clonus, Babinski sign bilateral positive. Laboratory examination: