神經性厭食症併發急性肝炎：個案報告

Case Report: Anorexia Nervosa with Complication of Acute Hepatitis

10.3966/168232812018062802004

張毓哲(Yu-Che Chang)；李福春(Fu-Chun Lee)；葉運強(Yun-Chiang Yeh)；楊惠茹(Hui-Ru Yang)

神經性厭食症 ； 神經性厭食症併發症 ； 再灌（進）食 ； 急性肝炎 ； 跨領域團隊合作照護 ； acute hepatitis ； anorexia nervosa ； complication of anorexia nervosa ； multidisciplinary coordination care ； refeeding

台灣家庭醫學雜誌

28卷2期（2018 / 06 / 01）

86 - 93

繁體中文

神經性厭食症(anorexia nervosa)是一種嚴重的飲食失調症(eating disorder)，由於對自己體重或身材過度的在意，藉由節食、運動、催吐等方式讓體重盡可能的遠遠低於正常範圍。常發生在女孩和婦女，初發年齡多在15歲到24歲之間。會引起多重系統異常，包括皮膚、內分泌、心臟血管、消化、神經、肌肉、骨骼系統等。肝功能異常是常見的併發症，但是嚴重的急性肝炎卻是很罕見的。藉由回顧一位24歲罹患神經性厭食症合併急性肝炎的住院的個案，經由跨領域團隊合作照護模式成功的讓病人體重逐漸增加、肝功能逐漸改善、順利出院回到正常生活，來探討本病症的流行病學、臨床徵狀、急性肝炎併發症以及計畫性再灌（進）食的治療建議。

Anorexia nervosa (AN), both a severe mental illness and a serious eating disorder, drives a person to maintain a dangerously low body weight by relentless measures like strict dieting, vigorous exercise, and intentional vomiting. The groups of people most commonly affected by AN are girls and young women, and the average age of onset for this disorder falls in the range of 15 to 24. AN can lead to abnormalities in multiple systems, including dermatological, endocrine and metabolic, cardiovascular, neurological, digestive, and skeleton-muscular systems. While mildly abnormal liver function is common in AN, severely elevated liver function remains rare. The case report presents a 24-year-old woman admitted to hospital through family medicine OPD due to anorexia nervosa with the complication of acute hepatitis. With the coordinated care of a multidisciplinary team, her liver function, appetite and weight improved gradually and her occupational function recovered after discharge. Epidemiology, clinical manifestations, complications and refeeding treatment of anorexia nervosa were also introduced after literature review.

1. (2013).Diagnostic and statistical manual of mental disorders: DSM-5 5.Washington:American Psychiatric Publishing.
2. De Caprio, C,Alfano, A,Senatore, I,Zarrella, L,Pasanisi, F,Contaldo, F(2006).Severe acute liver damage in anorexia nervosa: two case reports.Nutrition,22,572-5.
3. Hofer, M,Pozzi, A,Joray, M(2014).Safe refeeding management of anorexia nervosa inpatients: an evidence-based protocol.Nutrition,30,524-30.
4. Kamal, N,Chami, T,Andersen, A,Rosell, FA,Schuster, MM,Whitehead, WE(1991).Delayed gastrointestinal transit times in anorexia nervosa and bulimia nervosa.Gastroenterology,101,1320-4.
5. Mehanna, HM,Moledina, J,Travis, J(2008).Refeeding syndrome: what it is, and how to prevent and treat it.BMJ,336,1495-8.
6. Mehler, PS,Brown, C(2015).Anorexia nervosa -medical complications.J Eat Disord,3,11.
7. Narayanan, VGaudiani, JL,Harris, RH,Mehler, PS(2010).Liver function test abnormalities in anorexia nervosa-cause or effect.Int J Eat Disord,4,378.
8. Smink, FR,van Hoeken, D,Hoek, HW(2012).Epidemiology of eating disorders: incidence, prevalence and mortality rates.Curr Psychiatry Rep,14,406-14.
9. Strumia, R(2005).Dermatologic signs in patients with eating disorders.Am J Clin Dermatol,6,165-73.
10. 黃韵捷、周桂如(2015)。運用全民健康保險資料庫分析台灣地區神經性厭食症患者之住院醫療利用。榮總護理，32，121-7。

1. 傅柏畯,林靖芸(2021)。一位青春期厭食症個案之照護經驗。領導護理，22(4)，56-70。
2. 黃鴻鈞,洪偉欽,姚韋如(2022)。運動與厭食症：適應身體活動及運動處方觀點。中華體育季刊，36(2)，201-210。