Acquired Hypocupremia After Gastric Surgery
Acquired Hypocupremia After Gastric Surgery
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DOI：
10.1016/s1542-3565(04)00546-4
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发表时间：
2004-12-01
影响因子：
12.6
通讯作者：
Gross, John B., Jr.
中科院分区：
文献类型：
--
作者：
Kumar, Neeraj;Ahlskog, J. Eric;Gross, John B., Jr.
背景与目的：人体对铜的吸收可能发生在胃和十二指肠。铜对于神经系统的结构和功能是必不可少的，并且已经认识到人类获得性铜缺乏会导致类似于维生素B-12缺乏的脊髓病。后天性铜缺乏症并不是一个公认的胃手术并发症。在门克斯病中，肠上皮细胞转运吸收的铜的缺陷导致十二指肠粘膜中铜含量增加和低铜血症。方法：我们报告2例患者在胃手术后多年发生神经功能缺损伴铜缺乏。在另外2例患有低铜血症性脊髓病但无胃手术史的患者中，测量结肠铜以确定是否与Menkes病相似的吸收缺陷可能导致低铜血症。结果：4例患者均以铜缺乏为病因。2例患者在胃手术后出现铜缺乏。从文献中确定了另外8例胃手术后铜缺乏的患者。这8例患者中有6例也有神经系统表现。2例无手术史的低铜血症患者结肠粘膜铜含量增加。结论：获得性铜缺乏可能是胃手术的延迟并发症，并可能导致类似于维生素B-12缺乏的脊髓病。在一些获得性铜缺乏的患者中，低铜血症的原因可能不明显，应考虑原发性吸收缺陷。
Background & Aims: Copper absorption in humans probably occurs in the stomach and duodenum. Copper is essential for the structure and function of the nervous system and acquired copper deficiency in humans has been recognized to cause a myelopathy that resembles vitamin B-12 deficiency. Acquired copper deficiency is not a well-recognized complication of gastric surgery. In Menkes' disease a defect in enterocyte transport of absorbed copper results in increased copper content in the duodenal mucosa and hypocupremia. Methods: We report 2 patients who developed neurologic deficits with copper deficiency many years after gastric surgery. In 2 other patients with hypocupremic myelopathy but no history of gastric surgery, colonic copper was measured to determine if an absorptive defect similar to that seen in Menkes' disease may be responsible for hypocupremia. Results: In all 4 patients copper deficiency was identified as the cause of the myelopathy. In 2 patients the copper deficiency occurred after gastric surgery. Eight additional patients with copper deficiency after gastric surgery were identified from the literature. Six of these 8 patients also had neurologic manifestations. Colonic mucosa copper content was increased in the 2 patients with hypocupremia without prior gastric surgery. Conclusions: Acquired copper deficiency may be a delayed complication of gastric surgery and may result in a myelopathy similar to that seen with vitamin B-12 deficiency. In some patients with acquired copper deficiency no cause for the hypocupremia may be evident and a primary absorptive defect should be considered.