电子计算机辅助教学课件-精选.ppt

Liver failure 肝衰竭 protein NH3 NH3 urea × Blood NH3↑ * Liver failure 肝衰竭 protein NH3 NH3 urea × 血 NH3↑ Shunting Circulation 门- 体分流 ↑ * Liver failure 肝衰竭 protein NH3 NH3 urea × Blood NH3↑ Shunting Circulation 门- 体分流 NH3↑ ↑ * 氨中毒学说 氨对脑组织的毒性作用(detrimental effect of ammonia on CNS) 1.干扰脑能量代谢(disturbing energy metabolism) 2.干扰脑内神经递质(disturbing cerabral neutrotransmitter) 3.干扰神经细胞膜离子转运(disturbing membrane ion transport) * 1.干扰脑能量代谢(disturbing energy metabolism) NADH NAD NH3 NH3 ?-酮戊二酸 谷氨酸 谷氨酰胺 ATP （2）NADH消耗过多，呼吸链递氢受阻；ATP产生 （3）ATP消耗过多。 （1）进入三羧酸循环的?-酮戊二酸 ，ATP产生 * ATP encephalopathy ? * 草酰乙酸 琥珀酸 柠檬酸 α-酮戊二酸 谷氨酸↓ 谷氨酰胺↑ ＋NH3↑ ATP NADH NAD ＋NH3↑ 丙酮酸 乙酰辅酶A 乙酰胆碱↓ 胆碱 ＋ NH3↑ × γ-氨基丁酸↑ NH3↑ × 2.干扰脑内神经递质—神经介质成分改变 * 脑内神经递质异常(abnormal neutrotransmitter) 兴奋性递质 (exciting neutrotransmitter)↓ 抑制性递质 (inhibiting neutrotransmitter)↑ 脑功能 抑 制 disturbed brain function * 3.干扰神经细胞膜离子转运(disturbing membrane ion transport) 细胞 Na+-K+-ATP酶 Na+ Na+ K+ K+ NH3 * 假性神经递质学说(FNT hyputhesis) 假性神经递质 (false neurotransmitter, FNT) * HO HO CHOHCH2NH2 CHOHCH2NH2 HO CHOHCH2NH2 HO HO CHCH2NH2 * HO HO CHOHCH2NH2 CHOHCH2NH2 HO CHOHCH2NH2 HO HO CHCH2NH2 去甲肾上腺素 noradrenaline 多巴胺 dopamine 苯乙醇胺 phenylethanolamine 羟苯乙醇胺 octopamine * FNT形成的机制(mechanism of FNT synthesis) * gut liver brain Normal metabolism 酪胺 苯乙胺 Tyramine phenylethylamine Tyrosine phenylalanine 酪氨酸 苯丙氨酸 酪胺 苯乙胺 MAO * Tyrosine tyramine phenylalanine phenylethylamine Liver failure Tyramine phenylethylanine * Tyrasine tyramine phenylalanine phenylethylamine Liver Failure 肝衰竭 Shunting 门- 体分流 Tyramine phenylethylamine ↑ ↑ 酪胺 苯乙胺 * Tyrasine tyramine phenylalamine phenylethylamine Liver failure 肝衰竭 Shunting 门- 体分流 Octopamine phenylethanolamine 羟苯乙醇胺 苯乙醇胺 酪氨酸 苯丙氨酸 酪胺 苯乙胺 ?-羟化酶 * FNT引起脑病的机制(possible mechanism leading to encephalopathy) FNT↑ replacing NNT （取代） Disturbing