Anorexia Nervosaにみられる重篤な肝障害

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During the period between 1983 and 1989,thirty-four patients with anorexia nervosa were admitted to our hospital. Five of these cases were suffering from severe liver injury. Case I was a 16-year-old girl (height : 156cm, weight : 27kg). She showed GOT : 321U, GPT : 220U, LDH : 1082U, CPK : 581U, UN : 89mg/dl. PT : 40%. HPT : 37%. She recovered with fluid therapy administered via central venous catheter, but she also received a blood transfusion to correct anemia that developed during the clinical course. (cf. GOT : aspartate aminotransferase (ASAT), GPT : alanine aminotransferase (ALAT), CPK : creatine phosphokinase, UN : urea nitrogen, PT : prothrombin time. HPT : hepaplastin test.) Case 2 was a 17-year-old girl (153cm, 27kg) with severe liver injury. GOT : 2070U, GPT : 679U, PT29%, HPT : 21%. She died of heart failure in spite of a positive response to fluid therapy. Case 3 was a 20-year-old man (165cm, 29kg) with the following profile : GOT : 4710U, GPT : 856U, T. Bil : 5.3mg/dl. PT : 71%. HPT : 58%. He recovered with fluid therapy. Case 4 was a 17-year-old girl (151cm, 26kg). She, showing GOT : 266U, GPT : 638U, recovered with fluid therapy. Case 5 was a 15-year-old girl (162cm, 30kg). She, showing GOT : 2230U. GPT : 1940U, recovered with fluid therapy. The five cases reported shared a relatively similar clinical course. Their body weight losses were over 40% of standard body weight, and they were losing their body weight progressively. Elevated GOT and GPT scores coincided with complaint of muscle weakness and fatigue. Four of them showed a bleeding tendency. Their liver condition responded well to adequate fluid therapy. Fluid therapy with volumes of 500ml/day was not effective. We found fluid therapy in amounts exceeding 1500ml/day, 500kcal/day to be effective in treating this kind of case. HBs-Antigen was negative in all cases. During the course of treatment, normocytic anemia developed in all cases, two of which required blood transfusions. In cases 1 and 2,symptoms of heart failure increased. In cases 3 and 5,Iiver injury with body weight loss was recurrent. These cases suggest that severe liver injury is not rare in patients with anorexia nervosa. Patients with rapid, progressive body weight loss and complaints of muscle weakness should be payed careful attention during the clinical course.
日本心身医学会の論文
1992-06-01

Anorexia Nervosaにみられる重篤な肝障害

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