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病例1 患者男性,37岁,工人。因双手红肿,纳差2月,幻视20d入院。患者2月前发现双手红肿,继而肤色呈红褐色,1月前双手背皮肤变薄并有色素沉着。病后食欲下降,进食量由原来的0.5kg降至200—250g。勉强进食后上腹部饱胀不适,时有恶心及腹泻。近20d经常幻视,睡眠差,多梦易惊。患者有经常大量饮酒史,每天约250ml,平时少食蔬菜,食肉类较多。查体:BP20.5/14.7kPa.表情呆滞,双手背皮肤星褐色,有角化性鳞屑及色素沉着,与前臂正常皮肤有一清晰界限。舌及口腔粘膜红肿、糜烂。皮肤活检病理报告:表皮角化过度,上皮萎缩,上皮突消失,真皮内纤维组织增生。皮肤附件可见,组织内有少量淋巴细胞浸润。符合烟酸缺乏症病理改变。给予烟酸100mg,每日一次静滴,1周后幻视消失,食量增至每日400g,治疗1月后双手背皮肤恢复正常。
Case 1 Patient Male, 37 years old, worker. Due to both hands inflamed, anorexia in February, visual paralysis 20d admission. Patient was found to have both hands red and swollen two months ago, followed by a reddish-brown skin tone, thinning and pigmentation of his back two months ago. Loss of appetite after illness, food intake dropped from the original 0.5kg 200-250g. After reluctantly upper abdomen distention, nausea and diarrhea. Nearly 20d visual hallucinations, poor sleep, more dreams easy to panic. Patients often have a large number of drinking history, about 250ml per day, usually eat less vegetables, meat more. Physical examination: BP20.5 / 14.7kPa. Dull expression, both hands back star-brown skin, keratinized scales and pigmentation, and forearm normal skin has a clear boundary. Tongue and oral mucosal swelling, erosion. Skin biopsy pathology report: epidermal hyperkeratosis, epithelial atrophy, epithelial processes disappear, dermal fibrosis. Skin attachment visible, a small amount of tissue infiltration of lymphocytes. In line with the pathological changes of niacin deficiency. Given niacin 100mg, once daily intravenous infusion, disappeared after 1 week visual acuity, food intake increased to 400g daily, after 1 month of treatment both hands back to normal skin.