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摘要


目的 高血氨性腦病變是一罕見的化學治療併發症。此篇研究是為了分析本院大腸直腸癌病人接受化學治療後的高血氨性腦病變臨床上的表現。方法 本研究回溯收集台北榮民總醫院大腸直腸外科資料庫,於2000至2011年間,共有6740位診斷結腸直腸癌的病患,其中在10 位病患上發生了11 次高血氨性腦病變。將這些病人的臨床及病理的資料予以分析。結果 這10 位病患分別為6位男性及4位女性,有7位結腸腫瘤,3位直腸腫瘤。平均血氨濃度為233.5 ± 110.0 mmol/L(範圍:64.3-369.0 mmol/L)。24小時後追蹤平均血氨濃度為42.6 ± 16.3 mmol/L(範圍:17.9-66.7 mmol/L)。在高血氨性腦病變發生後,三位病人接受完整的靜脈化學治療,三位病人接受減低劑量的靜脈化學治療,三位病人接受口服化學治療,一位病人沒有接受任何化學治療。有一位病患產生了復發的高血氨性腦病變。結論 高血氨性腦病變的病因不明,而且與肝炎及肝功能無關。大部分的病人可以完全康復,且繼續使用相同的藥物對大部分病人來說是安全的。

並列摘要


Purpose. Hyperammonemic encephalopathy is an uncommon complication of chemotherapy in patients with colorectal cancer. This study describes the clinical features of hyperammonemic encephalopathy in patients who had colorectal cancer and were undergoing chemotherapy.Methods. Data were obtained retrospectively from a prospectively collected database of colorectal malignancies at Taipei Veterans General Hospital. During 2000-2011, 6740 patients were diagnosed with colorectal malignant tumors, and 11 hyperammonemic encephalopathy events occurred in 10 of these patients. These 10 patients were finally included in the study; of these, 3 (30%) had stage III and 7 (70%) had stage IV disease.Results: The patients (men, 6; women, 4) had primary rectal (n = 3) and colon (n = 7) tumors. The mean ammonia level was 233.5 ± 110.0 mmol/L (range: 64.3-369.0 mmol/L). The follow-up mean ammonia level at 24 hours was 42.6 ± 16.3 mmol/L (range: 17.9-66.7 mmol/L). After the patients developed hyperammonemic encephalopathy, 3 (30%) completed the full intravenous chemotherapy course, 3 (30%) reduced their dosage, and 3 (30%) shifted to oral chemotherapy; chemotherapy was stopped for 1 (10%) patient. One patient experienced recurrent hyperammonemic encephalopathy following chemotherapy (11.1%).Conclusion. The etiology of hyperammonemic encephalopathy has not been previously clarified and was not related to the hepatitis profile or liver function in this study. Recovery from hyperammonemic encephalopathy was complete in most patients. Rechallenge with the same regimen should be safe in most cases.

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