Wallace Jodi-Anne M, Udquim Krizia-Ivana T, Starnes Thomas A, Radhakrishnan Nila S
Department of Internal Medicine, Division of Hospital Medicine, University of Florida, Gainesville, Florida, USA.
Asheville Orthopaedic Associates, Asheville, North Carolina, USA.
Eur J Case Rep Intern Med. 2023 Apr 27;10(5):003675. doi: 10.12890/2023_003675. eCollection 2023.
A 30-year-old woman with a history of anorexia nervosa was admitted with weight loss, hypoglycaemia and electrolyte disturbances. During her admission, transaminases peaked at ALP 457 U/l, AST 817 U/l and ALT 1066 U/l. Imaging and laboratory findings were unrevealing, and she declined liver biopsy. Nutrition was introduced via a nasogastric tube and she demonstrated improvement in her laboratory values over several weeks. Her transaminitis was determined to be secondary to severe malnutrition, which has been previously described, but cases with such profound transaminitis are less common. Studies have demonstrated hepatic autophagocytosis as the likely cause.
Anorexia nervosa can cause severe liver injury as manifested in AST and ALT levels in the thousands.The slow reintroduction of enteral feeding can reverse liver injury.The mechanism is unclear but autophagocytosis of liver cells likely contributes to this phenomenon.
一名有神经性厌食症病史的30岁女性因体重减轻、低血糖和电解质紊乱入院。住院期间，转氨酶达到峰值，碱性磷酸酶（ALP）为457 U/l，天冬氨酸转氨酶（AST）为817 U/l，丙氨酸转氨酶（ALT）为1066 U/l。影像学和实验室检查结果均无异常，她拒绝了肝活检。通过鼻胃管给予营养支持，几周内她的实验室检查值有所改善。她的转氨酶升高被确定为继发于严重营养不良，此前已有相关描述，但转氨酶如此显著升高的病例较少见。研究表明肝自噬可能是其原因。
神经性厌食症可导致严重肝损伤，表现为AST和ALT水平达到数千。缓慢重新引入肠内营养可逆转肝损伤。机制尚不清楚，但肝细胞自噬可能导致了这一现象。
