Permalink : http://hdl.handle.net/2115/90519

KEYWORDS : Plummer-Vinson症候群;鉄欠乏性貧血;鉄補充療法;舌炎;上行結腸癌;Plummer‒Vinson syndrome;Iron deficiency anemia;Iron replacement therapy;Glossitis;Ascending Colon Cancer

【目的】鉄欠乏性貧血は，鉄不足により血色素産生が阻害され，小球性低色素性貧血を示す疾患である．口腔粘膜の萎縮や再生不良による舌炎や口角炎が生じるが，これに嚥下障害を伴った場合Plummer-Vinson症候群と呼ばれる．鉄欠乏性貧血の診断に関して，末梢血液検査では，小球性低色素性貧血（MCV 80以下，MCHC 30以下）を示しヘモグロビン値（Hb）が低下し，生化学的検査では，血清鉄（Fe）60 μg/dL以下，血清フェリチン値の低下，総鉄結合能（TIBC）および不飽和鉄結合能（UIBC）が増加する．今回，味覚異常を主訴として嚥下困難感，舌の疼痛に加えて鉄欠乏性貧血を合併した患者に対して，鉄補充療法により各症状が著明に改善し，鉄欠乏性貧血の原因として上行結腸癌を認めた症例を経験したので報告する． 【症例】70歳，女性．味覚異常と嚥下困難感を主訴に来院した．眼瞼結膜蒼白，舌乳頭の一部萎縮を認め，初診時の血液検査の結果は，MCV 69 f l，MCHC 24.6 pg，Fe 6 μg/dL，Hb 4.1 g/dL，TIBC 445 μg/dL，UIBC 437 μg/dLであった．Plummer-Vinson症候群の診断のもと，クエン酸第一鉄ナトリウムおよびピロリン酸第二鉄により鉄補充療法を行い，経時的に血液検査を実施した． 【経過】鉄補充療法開始2 か月後，眼瞼結膜の充血，舌乳頭の回復，口腔内症状の改善が認められた．また，血液検査にてFeおよびHbの上昇，TIBCおよびUIBCの減少が認められた．その後，消化器内科にて鉄欠乏性貧血の原因に関して精査を行った結果，上行結腸癌が認められた． 【結論】Plummer-Vinson症候群に対し適切に鉄補充療法を行うことで，早期に口腔内症状および血液検査値の改善が認められるが，長期的な改善を認めない難治性の症例に対しては，鉄欠乏性貧血に関して積極的な原因精査の必要があると示唆された．
Iron deficiency anemia is the most common type of anemia in Jap an, and iron deficiency inhibits blood pigment production, resulting in microcytic hypochromic anemia. Glossitis and angular cheilitis occur owing to the atrophy of the oral mucosa and poor regeneration of the mucosal epithelium. When this is accompanied by dysphagia, it is called Plummer‒Vinson syndrome. Regarding the diagnosis of the iron deficiency anemia, peripheral blood tests reveal microcytic hypopigmented anemia (MCV, ≤80 ; MCHC, ≤30), and the hemoglobin level (Hb) decreases. Biochemical tests reveal a decreased serum iron (Fe) level of <60 μg/dL, decreased serum ferritin levels, and increased total iron binding capacity (TIBC) and unsaturated iron-binding capacity (UIBC). We report a case of Plummer‒Vinson syndrome with the considerable improvement of oral symptoms by iron replacement therapy, and ascending colon cancer was found to be the cause of the iron deficiency anemia. 　A 70-year-old woman complained of abnormal taste. Her eyelid co njunctiva was pale, and her oral cavity showed a partial atrophy of the tongue papillae. Blood test results at h er first visit were as follows: MCV, 69; MCHC, 24.6; Fe, 6 μg/dL; Hb, 4.1 g/dL; TIBC, 445 μg/dL; and UIBC, 437 μg/dL. With the Plummer‒Vinson syndrome diagnosis, the iron replacement therapy with sodium ferrous citrate (Feromia®) and ferric pyrophosphate (Incremin®) was started and blood tests were performed over time. Two months after starting the iron replacement therapy, the hyperemia of the palpebral conjunctiva, recovery of the tongue papillae, and imp rovement of oral symptoms were observed. Blood test results are as follows: Fe, 99 μg/dL; Hb, 10 g/dL; TIB C, 329 μg/dL; and UIBC, 230 μg/dL. Incr eased Fe and Hb levels and decreased TIBC and UIBC levels were observed. Thereafter, ascending colon cancer was confirmed based on the results of a detailed examination of the cause of the iron deficiency anemia at the Department of Gastroenterology. 　These results suggest that the appropriate iron replacement the rapy for Plummer‒Vinson syndrome improves oral symptoms and blood test results at an early stage. Moreover, the active examination of the cause of the iron deficiency anemia was suggested to be necessary for refractory cases not showing long-term improvement.