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栄養状態の回復期にカルニチン欠乏および高CPK血症をきたした神経性食欲不振症を報告した.症例は30歳女性.入院時体重は19.6kg(-57%標準体重).入院時より高度の肝機能障害を認めたが, 栄養状態の改善に伴い入院30日目には正常化した.しかし, そのころよりCPKが上昇しはじめ, 入院時は正常範囲にあった血清カルニチン濃度が正常の半分以下まで低下した.その後, 摂食量の増加にもかかわらず, 血清カルニチン濃度はわずかに上昇したのみで, CPKも漸減しただけであった.そこでカルニチン製剤を投与したところ, CPK, カルニチンともに速やかに正常化した.神経性食欲不振症の栄養状態の回復期におけるCPKの上昇とカルニチンの関連を考察した.
Anorexia nervosa with serum carnitine deficiency and high creatine phosphokinase(CPK)concentration during the nutritional rehabilitation period is reported. A 30-year-old woman was admitted to the department of psychosomatic medicine at Kyushu University Hospital because of extreme emaciation(body weight, 19.6kg ; -57% standard body weight)and severe liver dysfunction. With an improvement of the nutritional state, liver function normalized by the 30th hospital day. However, when the liver function normalized, serum CPK concentration began to elevate and serum carnitine concentration, which had been within the normal range on admission, reduced to less than half the normal value. In spite of the fact that daily calolic intake increased, serum carnitine concentration did not sufficiently increase and serum CPK concentration slightly decreased. After carnitine product administration, both serum CPK and carnitine concentration quickly normalized. We discussed the relation between carnitine and serum CPK elevation during nutritional rehabilitation in an anorexia nervosa patient.
