Kawakubo K, Iida M, Matsumoto T, Mochizuki Y, Doi K, Aoyagi K, Fujishima M
Second Department of Internal Medicine, Faculty of Medicine, Kyushu University, Fukuoka City, Japan.
Postgrad Med J. 1994 Mar;70(821):215-9. doi: 10.1136/pgmj.70.821.215.
The case of a patient with Crohn's disease complicated by progressive and irreversible encephalopathy, who had been on long-term total parenteral nutrition due to short bowel syndrome, is described. He initially experienced a disturbance of his vision, which was followed by various neurological symptoms during the next 3 years. These symptoms rapidly progressed until he finally developed consciousness disturbance. He also manifested erythrocytic macrocytosis, a low serum level of tri-iodothyronine and a high level of thyroxine. His blood levels of various trace minerals and vitamins were normal, except for selenium, which showed extremely low values. In addition, impaired plasma glutathione peroxidase activity was confirmed. After intravenous supplementation of selenium, macrocytosis, tri-iodothyronine and thyroxine values, and glutathione peroxidase activity all became normalized, yet he improved little neurologically. Our case suggests that long-term selenium deficiency may cause progressive and irreversible encephalopathy, and that careful monitoring of this mineral is necessary when an excessive period of total parenteral nutrition is being considered in the clinical setting.
本文描述了一名克罗恩病患者的病例，该患者因短肠综合征长期接受全胃肠外营养，并发进行性不可逆性脑病。他最初出现视力障碍，随后在接下来的3年中出现各种神经症状。这些症状迅速进展，直至最终出现意识障碍。他还表现为红细胞大细胞性贫血、血清三碘甲状腺原氨酸水平低和甲状腺素水平高。除硒水平极低外，他的各种微量矿物质和维生素血液水平均正常。此外，还证实血浆谷胱甘肽过氧化物酶活性受损。静脉补充硒后，大细胞性贫血、三碘甲状腺原氨酸和甲状腺素值以及谷胱甘肽过氧化物酶活性均恢复正常，但他的神经功能改善甚微。我们的病例表明，长期硒缺乏可能导致进行性不可逆性脑病，并且在临床环境中考虑长时间全胃肠外营养时，有必要仔细监测这种矿物质。
