Theiler R, Wirth H P, Flury R, Hanck A, Michel B A
Rheumaklinik, Universitätsspital Zürich.
Schweiz Med Wochenschr. 1993 Dec 28;123(51-52):2405-12.
The case of a 69-year-old woman with a chronic vitamin A intoxication syndrome after self-administration of vitamin A is presented. The clinical picture included musculoskeletal disorders, headache and hepatomegaly. The diagnosis of chronic vitamin A intoxication was based on a history of excessive vitamin A ingestion, clinical chemistry and needle biopsy of the liver. Besides retinol and retinyl ester, the serum concentration of retinol-binding protein (RBP) should be determined. Whereas the serum retinol concentration in chronic vitamin A intoxication often does not correlate with toxicity, the ratio between retinol and RBP and the concentration of retinyl ester is more sensitive. Morphological alterations are associated with the cumulative dosage of ingested vitamin A, whereas the daily amount of vitamin A determines the latency until pathological changes occur. The hormone-like, retinoid-receptor mediated molecular mechanism of action seems to be responsible for the multisystemic manifestations in chronic vitamin A intoxication syndrome.
本文报告了一例69岁女性在自行服用维生素A后出现慢性维生素A中毒综合征的病例。临床表现包括肌肉骨骼疾病、头痛和肝肿大。慢性维生素A中毒的诊断基于过量摄入维生素A的病史、临床化学检查以及肝脏穿刺活检。除了视黄醇和视黄酯外，还应测定血清视黄醇结合蛋白（RBP）的浓度。在慢性维生素A中毒中，血清视黄醇浓度通常与毒性无关，而视黄醇与RBP的比值以及视黄酯的浓度更为敏感。形态学改变与摄入维生素A的累积剂量有关，而每日维生素A摄入量则决定了病理变化出现的潜伏期。激素样、类视黄醇受体介导的分子作用机制似乎是慢性维生素A中毒综合征多系统表现的原因。
