骨髓增生异常综合征与巨幼细胞性贫血、再生障碍性贫血的细胞形态学对比分析

目的探讨骨髓增生异常综合征与巨幼细胞性贫血、再生障碍性贫血在细胞形态学上的区别。方法通过外周血细胞计数、外周血镜检分类、骨髓涂片、骨髓铁染色等检验方法,重点分析骨髓增生异常综合征和巨幼细胞性贫血、再生障碍性贫血在红细胞系、粒细胞系以及巨核细胞系细胞形态上的共性与差异。结果在所分析的病例中,外周血三系均出现一系或多系的降低。骨髓涂片中,骨髓增生异常综合征与巨幼细胞性贫血在细胞核畸变上难以区分,在红细胞系、粒细胞系巨幼(样)变方面差异有统计学意义(P0.05)。骨髓增生异常综合征与再生障碍性贫血在细胞核畸变方面差异有统计学意义(P0.05)。淋巴样小巨核细胞是骨髓增生异常综合征与其他2种疾病的重要区别。结论骨髓增生异常综合征与巨幼细胞性贫血、再生障碍性贫血在细胞形态学上既有相似又有不同之处。这些不同点有助于这3种疾病的鉴别与诊断。     

巨幼细胞贫血的诊断及现代治疗

巨幼细胞贫血的诊断及现代治疗中国医科大学第二临床学院内科（１１０００３）韩乃英巨幼细胞贫血多见于叶酸、维生素Ｂ１２缺乏或其他原因引起ＤＮＡ合成障碍所致的一组贫血。其特点是骨髓中出现大量巨幼细胞，粒系、巨核系也伴有质的异常和量的改变。外周血可见全血细胞...     

血液系统疾病查房会诊（五）——巨幼细胞贫血

巨幼细胞贫血是维生素B12、叶酸缺乏或其他原因引起脱氧核糖核酸合成障碍的贫血。1西医查房 1．1诊断依据①病史：有妊娠、饮食、胃肠道疾病、药物等引起营养不良的病史,面色苍白,疲乏无力。②实验室检查：血象呈中、重度贫血,红细胞形态以大细胞为主,骨髓象代偿性增生,三系列巨幼变以红系最为明显,血清叶酸、维生素B12含量减低。     

造血原料缺乏引起的贫血

正造血原料缺乏所致的贫血是目前最常见的贫血,缺铁或者铁利用障碍主要影响血红蛋白的合成,引起缺铁性贫血,简称缺铁贫;叶酸和维生素B_(12)是DNA合成过程中十分重要的两种辅酶,缺乏会引起巨幼细胞性贫血,简称巨幼贫。     

骨髓增生异常综合症分型及与巨幼细胞性贫血的鉴别

骨髓增生异常综合征是一组克隆性造血紊乱的异质组群,以全血细胞减少及骨髓病态造血为主要表现,并易于向白血病转化。巨幼细胞性贫血是由于脱氧核糖核酸(DNA)合成障碍所致的贫血,主要是因体内缺乏叶酸或维生素B12引起。     

叶酸在儿科的新用途

叶酸在儿科的新用途文／开敏图／杨青叶酸（维生素Ｍ）属Ｂ族维生素，在体内被还原为四氢叶酸，参与体内核酸合成等，并与维生素Ｂ１２共同促进红细胞的生成和成熟，尤其适用于妊娠期和维生素Ｂ１２巨幼细胞性贫血的治疗。近年来，临床儿科医师将叶酸用于儿科一些疾病的防...     

老年巨幼细胞性贫血患者40例临床分析

目的 探讨老年巨幼细胞性贫血患者的临床及血液学特点.方法 对40例老年巨幼细胞性贫血患者(老年组)的临床资料进行回顾性分析,与同期24例非老年巨幼细胞性贫血患者(非老年组)进行血象和骨髓象比较.结果 老年组外周全血细胞减少25例(62.5％,25/40),非老年组6例(25.0％,6/24).老年组消化道内窥镜及造影检查显示伴消化道疾病者19例(47.5％,19/40).给予补充叶酸和维生素B12治疗后,老年组血红蛋白恢复正常的中位时间为28 d,较非老年组的20d要长(P＜0.05).结论 老年患者巨幼细胞性贫血的发生与慢性消化道疾病关系密切.骨髓穿刺、骨髓病理检查及叶酸、维生素B12浓度测定对于诊断和鉴别诊断尤为重要,同时应积极治疗原发病及并发症.     

巨幼细胞性贫血病因及防治

巨幼细胞性贫血（megaloblastic anemia,MA）主要系体内缺乏叶酸和（或）维生素B12（VitB12）弓l起的脱氧核糖核酸（DNA）合成障碍昕致的贫血,亦可因遗传性或药物等获得性DNA合成障碍引起。其特点为骨髓细胞呈典型的“巨幼变”,该臣幼红细胞易在骨髓内破坏,出现无效性红细胞生成。可累及红系、粒系和巨核系细胞,严重者可表现为全血细胞减少。     

我院86例巨幼细胞性贫血患者病因分析

目的探讨巨幼细胞性贫血的发病原因、临床特点及防治措施。方法通过回顾性分析病史及有关辅助检查结果,了解本院收治的86例巨幼细胞性贫血患者的发病原因及发病特征。结果消化道疾病43例,占50％,是具有细胞贫血的常见发病原因。给予叶酸、维生素B12以及升血药物治疗后患者的血红蛋白（Hb）、白细胞（WBC）、血小板（PLT）、网织红细胞计数（RC）、红细胞平均体积（MCV）均明显改善。结论我院巨幼细胞性贫血的病因系消化系统疾病、饮食习惯不良等,早发现、早治疗,并积极预防,纠正偏食等不良习惯,鼓励患者多食用富含叶酸、维生素B。食物是预防的关键。     

巨幼细胞性贫血与骨髓增生异常综合征的鉴别

目的:探讨HDL-C、α-HBDH、LDH、血生化BIL检测及细胞形态学变化在鉴别骨髓增生异常综合征(MDS)与巨幼细胞性贫血(MA)的价值.方法:选取2013年3月-2016年3月在我院收治的56例巨幼细胞性贫血患者,另选取同期骨髓增生异常综合征患者6例,回顾性分析所选取患者临床资料及HDL-C、α-HBDH、LDH、血生化BIL检测.结果:巨幼细胞性贫血的三系血细胞在巨幼程度方面相比于骨髓增生异常综合征更为明显,HDL-C、α-HBDH、LDH和血生化BIL明显升高,骨髓增生异常综合征骨髓除巨幼样出现变化之外,还存有形态异常状况.结论:巨幼细胞性贫血与骨髓增生异常综合征在细胞形态上,除具有诸多相似性之外,彼此间还具有各自特性,二者所具有的不同点在HDL-C、α-HBDH、LDH、血生化BIL检测及细胞形态上表现最为突出.     

血透患者血浆HCY和叶酸、VitB12浓度关系分析及干预研究

目的探讨血透患者血浆HCY和叶酸、VitB12浓度的关系及干预效果。方法选取透龄大于3个月的维持性血液透析患者280例,检测其血浆HCY、叶酸及VitB12浓度并进行分析。将其中60例HCY超过正常值两倍的患者随机分成两组,试验组予叶酸口服治疗1个月,对照组不予叶酸治疗,1个月后比较两组的HCY浓度及治疗效果。结果 280例血透患者中,有256例HCY浓度升高,其中11例叶酸浓度低于正常,余者叶酸浓度都在正常范围内;有232例VitB12浓度升高。相关分析显示,血浆HCY与叶酸、VitB12浓度无相关性(r=-0.023、0.003, P均>0.05)。治疗1个月后,试验组的HCY浓度显著低于对照组(P<0.05)。结论血透患者的血浆HCY与叶酸、VitB12浓度无相关性,口服叶酸治疗能明显降低血透患者的血浆HCY浓度。     

小儿再生障碍性贫血合并骨髓细胞病态造血现象的临床分析

目的 分析小儿再生障碍性贫血合并骨髓细胞病态造血现象.方法 选取资阳市第一人民医院2014年3月至2017年3月收治的40例再生障碍性贫血患儿作为A组,骨髓增生异常综合征患儿38例作为B组,再生障碍性贫血合并骨髓细胞病态造血患儿30例为C组,另选择同时期收治的来院体检的35例健康儿作为对照组,A组、B组及C组患儿采用对应的治疗方法,测定并比较治疗前后CD34+、叶酸及维生素B12的水平.结果 治疗前,A组、B组、C组与对照组相比CD34+、叶酸及维生素B12的水平均较低,C组与A组、B组相比CD34+降低更加显著,A组与B组相比CD34+降低更加显著,差异具有统计学意义(t=2.34~6.57,均P<0.05),A组、B组及C组叶酸及维生素B12的水平分别相比无明显差异(t=0.87~1.01,均P>0.05);治疗后,A组、B组及C组CD34+、叶酸及维生素B12水平均有所升高,但低于对照组,差异具有统计学意义(t=4.90~6.38,均P<0.05).A组、B组及C组治疗后CD34+、叶酸及维生素B12的水平相比无明显差异(t=0.56~0.88,均P>0.05).结论 小儿再生障碍性贫血合并骨髓细胞病态造血的血清学指标具有特殊,建议对患儿的血清叶酸及维生素B12的水平进行合理的检测和针对性治疗.     

老年冠心病与血浆同型半胱氨酸及其代谢相关因子

目的观察老年冠心病及糖尿病与血浆同型半胱氨酸及其代谢相关因子之间的关系。方法选择老年冠心病患者68例,其中伴发Ⅱ型糖尿病的16例为A组;无伴发Ⅱ型糖尿病52例为B组;选择22例健康老年人作为对照组C组。对受试者进行血浆同型半胱氨酸、叶酸和维生素B12定量测定。结果患病组老年血浆同型半胱氨酸值明显高于健康老年组,血浆Vit B12、叶酸值明显低于健康对照组,两组间比较有统计学意义(P<0.05),Ⅱ型糖尿病组(A组)血浆同型半胱氨酸值明显高于无糖尿病组(B组)(P<0.05),且A组VitB12和叶酸值明显低于B组(P<0.01),B组血浆同型半胱氨酸值高于C组,Vit B12明显低于C组(P<0.01),而叶酸两组间差别无统计学意义。患病组的同型半胱氨酸值和叶酸、VitB12呈明显的负相关,相关系数分别为-0.61和-0.49,P均<0.01。结论老年冠心病患者高同型半胱氨酸血症与动脉硬化、冠心病的发病及糖尿病胰岛素相对或绝对缺乏有密切关系,探讨老年人同型半胱氨酸的代谢规律对预防老年心脑血管疾病有重要意义。     

妊娠期高血压疾病患者血浆总同型半胱氨酸水平监测及其干预治疗的研究

目的:研究血浆总同型半胱氨酸(tHcy)水平和血清叶酸、维生素B12(VitB12)水平与妊娠期高血压疾病的关系并进行干预治疗研究。方法:测定350例妊娠期高血压疾病患者(A组)和350例正常晚期妊娠妇女(B组)血浆tHcy水平和血清叶酸、VitB12水平,并对妊娠期高血压疾病伴高同型半胱氨酸(Hcy)血症患者应用叶酸联合甲钴胺进行干预治疗(给予叶酸5mg,每日3次,甲钴胺500μg,每日1次,疗程4周),测定治疗前后患者血浆tHcy水平和血清叶酸、VitB12水平。结果:血浆tHcy水平A组显著高于B组(P<0.01),血清叶酸、VitB12水平A组显著低于B组(P<0.01);A组中83例伴高Hcy血症患者经叶酸联合甲钴胺干预治疗4周后,血浆tHcy水平显著下降(P<0.01),血清叶酸、VitB12水平显著上升(P<0.01)。结论:妊娠期高血压疾病患者血浆tHcy水平显著上升,血清叶酸、VitB12水平显著下降,叶酸联合甲钴胺干预治疗能使妊娠期高血压疾病伴高Hcy血症患者血浆tHcy水平显著下降。     

Folacin deficiency and requirement in the squirrel monkey (Saimiri sciuresus).

Acute folacin deficiency was studied in eight young squirrel monkeys (Saimiri sciureus). Half of the animals were fed a semipurified deficient diet (no added folic acid) and half were fed a control diet (0.84 mg of added folic acid per kilogram of dry diet). Monkeys fed the deficient diet lost weight and suffered from diarrhea and dehydration leading to the death of one of the animals after 6 weeks. Folacin deficiency also was studied in six older animals fed diets containing varying levels of added folic acid. Monkeys fed diets containing 0.14 or 0.27 mg of added folic acid per kilogram of dry diet slowly developed alopecia, a scaly dermatitis, and a mild macrocytic anemia. When these animals were fed the deficient diet, they lost weight rapidly, the alopecia and dermatitis worsened, excretion of formiminoglutamic acid in the urine increased, and a severe megaloblastic anemia with profound intramedullary hemolysis developed. Deficient monkeys had low plasma and red blood cell folacin values but maintained normal plasma vitamin B12 values. Repletion of the animals fed the deficient diet with injections of folic acid reversed both the hematological and physical deterioration. The folacin requirement for maintenance of body weight in these animals was 28 micrograms of total folacin per kilogram of body weight per day. More than 75 micrograms of total folacin per kilogram of body weight/day may be needed to assure growth and normal hematological parameters and bone marrow cytology.     

大剂量重组人促红细胞生成素治疗慢性肾衰竭贫血的效果及机制

目的：研究和探讨大剂量重组人促红细胞生成素用于慢性肾衰竭（CRF）贫血的临床治疗效果及治疗机制。方法：选取本院2012年3月-2014年3月收治的慢性肾衰竭贫血患者58例,所有患者均予以1.2万IU rHuEPO皮下注射,每周1次,共治疗8周。患者每日服用维铁缓释片1粒,并常规运用维生素B12和叶酸。检测患者的骨髓象、血象、SI、SF及铁粒幼细胞计数。结果：58例患者中显效28例,有效26例,无效4例,总有效率为93.1%。用药2周后患者的Ret、RBC、Hb、Hct开始升高,用药8周后血象红系各指标较用药前有显著升高,差异均有统计学意义（P〈0.01）。患者骨髓红系增生较治疗前而言活跃显著,且早幼红、中幼红、晚幼红和E值较用药前有显著升高,其中晚幼红增生最显著,故G/E值较用药前显著降低,经治疗8周后患者SI、SF及铁粒幼细胞值均显著降低,差异均有统计学意义（P〈0.05）。结论：大剂量重组人促红细胞生成素可有效用于慢性肾衰竭贫血患者的临床治疗,通过刺激骨髓造血的机理恢复机体的正常造血功能,在慢性肾衰竭贫血患者的临床治疗上具有广泛的发展前景。     

Low vitamin B-12 concentrations in patients without anemia: the effect of folic acid fortification of grain

BACKGROUND: In some patients with vitamin B-12 deficiency mistakenly treated with folic acid, anemia resolved but neurologic complications became worse (masking). Fortification of enriched cereal grains with folic acid has raised concerns that people who consume large quantities of cereal grains, particularly the elderly, may be at increased risk of masking. It is unclear, however, what proportion of people with low vitamin B-12 concentrations do not have anemia and whether the proportion is increasing. OBJECTIVE: We investigated whether fortification has increased the proportion of patients with low vitamin B-12 but without anemia. DESIGN: We reviewed the laboratory results of every patient for whom a vitamin B-12 concentration was measured at the Veterans Affairs Medical Center in Washington, DC, between 1992 and 2000. Those with a low vitamin B-12 concentration (< 258 pmol/L) had their hematocrits and mean cell volumes checked. The proportion without anemia was examined by year before, during, and after folic acid fortification began. RESULTS: There were 1573 subjects with a low vitamin B-12 concentration. The proportion without anemia did not increase significantly from the prefortification period (39.2%) to the period of optional fortification (45.5%) and the postfortification period (37.6%). These findings did not change when the analysis was limited to patients aged > 60 y or when a more conservative definition of low vitamin B-12 (< 150 pmol/L) was used. CONCLUSIONS: Despite evidence that folic acid exposure has increased dramatically since food fortification began, this population showed no evidence of an increase in low vitamin B-12 concentrations without anemia. If confirmed, these results would indicate that food fortification has not caused a major increase in masking of vitamin B-12 deficiency.     

高同型半胱氨酸血症与颈动脉粥样硬化对老年急性脑梗死影响的研究

目的：探讨老年急性脑梗死患者血清同型半胱氨酸（Hcy）水平与颈动脉硬化（CAA）程度之间的关系。方法：对80例老年急性脑梗死患者进行空腹血浆Hcy、空腹血糖、胆固醇、甘油三酯、叶酸、维生素B12（VitB12）水平的测定,并且进行彩超检查颈动脉内膜-中层厚度（IMT）、斑块大小、狭窄程度及血流速度的检测,按照颈动脉狭窄程度及IMT值分为A、B、C、D四组;对Hcy水平与叶酸、VitB12及其他相关因素进行分析。结果：（1）随着CAA程度的加重,Hcy水平升高,A、B、C组和D组之间比较差异均有统计学意义（P〈0.05）;（2）叶酸与VitB12的水平随着CAA程度的加重而降低,仅在A组和D组之间比较差异有统计学意义（P〈0.05）;（3）统计学分析表明血清Hcy水平与血叶酸和VitB12水平负相关（r=-0.328、-0.442,P〈0.05）。结论：高Hcy血症与颈动脉粥样硬化程度密切相关,是脑梗死发生的独立危险因素。     

原发支气管肺癌合并贫血的临床分析

目的 探讨原发支气管肺癌合并贫血的原因、特征及治疗。方法 回顾近十余年内我院334例肺癌住院患者的资料。结果 确诊支气管肺癌并发贫血76例，轻度34例，中度37例，重度5例。68例行骨髓穿刺涂片检查，确诊骨髓转移35例。7例患者用促红细胞生成素(EPO)治疗，近期有效。结论 肺癌并贫血约占22．8％，多为轻至中度。最常见的原因为骨髓转移，与营养不良、显性或不显性失血等因素也有关。EPO减少是否为重要原因，待进一步探讨。     

Homocysteine, vitamin B-12, and folic acid and the risk of cognitive decline in old age: the Leiden 85-Plus study

BACKGROUND: High concentrations of homocysteine and low concentrations of vitamin B-12 and folic acid are frequently observed in subjects with dementia. OBJECTIVE: We assessed whether serum concentrations of homocysteine, vitamin B-12, or folic acid predict cognitive decline in old age. DESIGN: This was a prospective, population-based, longitudinal study of 599 subjects (Leiden 85-Plus Study, Netherlands). The subjects were administered a battery of cognitive tests (including the Mini Mental State Examination, the Stroop test, a letter digit coding test, and a word recall test) at 85 y of age and yearly thereafter until 89 y of age. Serum concentrations of homocysteine, vitamin B-12, and folic acid were measured at 85 and 89 y of age. Cross-sectional associations between serum concentrations and cognition were assessed at 85 and 89 y of age. The association between baseline serum concentrations and subsequent longitudinal cognitive decline was assessed with the use of mixed linear models. RESULTS: In the cross-sectional analyses, serum concentrations of homocysteine and folic acid were significantly associated with cognitive performance, but serum concentrations of vitamin B-12 were not. In the longitudinal analyses, there were no significant associations of serum concentrations of homocysteine, vitamin B-12, or folic acid with rate of cognitive decline. CONCLUSIONS: Elevated serum concentrations of homocysteine and reduced folic acid are associated with cognitive impairment in elderly persons but do not predict an increased rate of cognitive decline. The association of high serum concentrations of homocysteine and low folic acid with cognitive impairment in old age is likely to be a consequence of disease and not a contributory cause.