Hatoff D E, Gertler S L, Miyai K, Parker B A, Weiss J B
Gastroenterology. 1982 Jan;82(1):124-8.
A case of acute hypervitaminosis A complicating viral hepatitis is reported. Twenty days after presenting with hepatitis B, a 42-yr-old vegetarian developed acute hypervitaminosis A in the absence of recent, massive exposure to the vitamin. Findings included headache, confusion, skin desquamation, and hypercalcemia. Prior to developing hepatitis, he had ingested supplemental vitamin A without recognized ill effect. Liver and serum vitamin A without recognized ill effect. Liver and serum vitamin A levels were both elevated; the liver biopsy showed abundant, lipid-filled Ito cells and perisinusoidal fibrosis. This case demonstrates that patients with excessive hepatic stores of vitamin A may develop hypervitaminosis A during acute, intercurrent liver disease. Levels of retinol binding protein are reduced in hepatitis. This phenomenon may account for the findings in this case, since vitamin A is more toxic when not specifically bound to retinol binding protein. The size of the population at risk for this complication of hepatitis in unknown, but presumably it is growing with the widespread use of supplemental vitamin A.
报告了一例急性维生素A过多症并发病毒性肝炎的病例。一名42岁的素食者在出现乙型肝炎20天后，在近期未大量接触该维生素的情况下发生了急性维生素A过多症。症状包括头痛、意识模糊、皮肤脱屑和高钙血症。在患肝炎之前，他曾摄入过补充维生素A，但未出现明显不良影响。肝脏和血清维生素A水平均升高；肝脏活检显示有大量充满脂质的伊托细胞和窦周纤维化。该病例表明，肝脏中维生素A储存过多的患者在急性并发肝病期间可能发生维生素A过多症。肝炎患者中视黄醇结合蛋白水平降低。这种现象可能解释了该病例中的发现，因为当维生素A未与视黄醇结合蛋白特异性结合时，其毒性更大。肝炎这种并发症的危险人群规模尚不清楚，但据推测，随着补充维生素A的广泛使用，这一人群可能在增加。
