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[遗传性粪卟啉病(肝性粪卟啉病),红细胞生成性粪卟啉病]

[Hereditary coproporphyria (Hepatic coproporphyria), Erythropoietic coproporphyria].

作者信息

Kiso S, Kawata S, Kashihara T, Tamura S, Matsuzawa Y

机构信息

Second Department of Internal Medicine, Osaka University Medical School.

出版信息

Nihon Rinsho. 1995 Jun;53(6):1433-7.

PMID:7616659
Abstract

Hereditary coproporphyria (Hepatic coproporphyria: HCP); HCP is the rarest and least recognized among hepatic porphyrias and is characterised by an excess of faecal and urinary excretion of coproporphyrin (mainly isomer III). The deficiency is in coproporphyrinogen oxidase. HCP was first described by Berger and Goldberg in 1955 and was considered an asymptomatic biochemical abnormality. It later became evident that HCP could provoke acute attacks similar to those of acute intermittent porphyria (AIP) and variegate porphyria (VP). Such episodes are often provoked by barbiturates, sulphonamides and other drugs, and include automatic symptoms (hypertension, tachycardia, abdominal pain, constipation), central (epileptic seizures, mental disturbances) and peripheral nervous system dysfunction. During acute attacks, urinary ALA (delta-aminole-vulinic acid) and PBG (porphobilinogen) are elevated just as in AIP and VP, however, a marked elevation of faecal COPRO (coproporphyrin) is diagnostic of HCP. Laparoscopic finding of our case showed a map-like appearance of the liver surface with slightly depressed dark-bluish areas and reddish-brown areas. The liver biopsy specimen showed red fluorescence under ultraviolet light. On HE staining, hydropic degeneration of the hepatocytes and many brown granules in the hepatocytes were seen. A part of the granules stained positive for iron. Schmorl's stain showed many needle-shaped crystallines. Erythropoietic coproporphyria (ECP); Heilmeyer and Clotten have described that elevated PROTO (protoporphyrin) and COPRO were found in the RBC of the patient. Topi et al. described two brothers with cutaneous photosensitivity similar to that of erythropoietic protoporphyria, but with elevated RBC PROTO and COPRO III in both. Very little is known about this disease.

摘要

遗传性粪卟啉病(肝性粪卟啉病:HCP);HCP是肝性卟啉病中最罕见且最不为人所认识的,其特征是粪便和尿液中粪卟啉(主要是异构体III)排泄过多。缺陷在于粪卟啉原氧化酶。HCP于1955年由伯杰和戈德堡首次描述,当时被认为是一种无症状的生化异常。后来发现HCP可引发类似于急性间歇性卟啉病(AIP)和杂合性卟啉病(VP)的急性发作。此类发作常由巴比妥类药物、磺胺类药物和其他药物诱发,包括自主症状(高血压、心动过速、腹痛、便秘)、中枢症状(癫痫发作、精神障碍)和周围神经系统功能障碍。在急性发作期间,尿δ-氨基-γ-酮戊酸(ALA)和卟胆原(PBG)与AIP和VP一样会升高,然而,粪便中粪卟啉(COPRO)的显著升高是HCP的诊断依据。我们病例的腹腔镜检查发现肝脏表面呈地图样外观,有略凹陷的暗蓝色区域和红棕色区域。肝脏活检标本在紫外线下显示红色荧光。苏木精-伊红(HE)染色显示肝细胞水样变性,肝细胞内有许多棕色颗粒。部分颗粒铁染色呈阳性。施莫尔染色显示有许多针状结晶。红细胞生成性粪卟啉病(ECP);海尔迈尔和克洛滕曾描述在患者的红细胞中发现原卟啉(PROTO)和粪卟啉升高。托皮等人描述了两兄弟,他们有类似于红细胞生成性原卟啉病的皮肤光敏性,但两人的红细胞PROTO和粪卟啉III均升高。关于这种疾病知之甚少。

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