Assessment of autonomic nervous system functions in patients with vitamin B12 deficiency by power spectral analysis of heart rate variability

The purpose of this study was to test the autonomic nervous system function of patients with vitamin B12 deficiency (megaloblastic anemia) by measuring heart rate variability (HRV). The study population consisted of 17 vitamin B12 deficient patients and 15 age- and sex-matched normal volunteers. HRV was measured by power spectral analysis from which power of the low frequency (LF) peak (0.04-0.15 Hz), normalized units of the LF peak (LFNU), power of the high frequency (HF) peak (0.15-0.4 Hz), normalized units of the HF (HFNU), and ratio of power of LF to power of HF (LF:HF) were calculated. Vitamin B12 deficient patients had lower LF, LFNU, HF, HFNU, and LF:HF ratio than normal volunteers (P < 0.05). Decreases in sympathetic indices (LF and LFNU) were greater than those measured in parasympathetic indices (HF and HFNU). All HRV parameters correlated positively with the level of vitamin B12 (P < 0.001) and negatively with the duration of disease (P < 0.001). After vitamin B12 replacement the HRV parameters of patients and controls became comparable (P > 0.05). Our data suggest that autonomic sympathetic and parasympathetic nervous activities are decreased in patients with vitamin B12 deficiency, an abnormality that can be corrected by vitamin B12 replacement therapy.     

Effect of fentanyl and vitamin B12 on abdominal pain in patients addicted to oral opium: A clinical trial

Background: Pain is a common complaint among patients referring to the emergency department. This study aimed at comparing the effect of fentanyl and vitamin B₁₂ to decrease the abdominal pain in patients who are addicted to oral opium.

Methods: This study conducted a double-blind randomized clinical trial on patients addicted to oral opium during a one-year period. The effects of fentanyl and vitamin B12 were compared for the relief of abdominal pain in such patients.

Results: The 136 patients studied had a mean age of 47.77 ± 13.6 years (mean ± SD). There was a significant difference in mean pain severity at 10, 15, 30, 45, 60, and 120 min (P < .05). The mean pain severity in the fentanyl group was significant at 30 min compared to the earlier times and showed a decreasing trend in pain severity (P < .05). This decreasing trend was observed up to 120 min for the fentanyl + vitamin B12 group, which showed a significant difference between each time and the time preceding it (P < .05).

Conclusions: The proper and permanent control of abdominal pain experienced by patients addicted to oral opium is essential. The combined use of fentanyl and vitamin B12 is effective in reaching this goal.     

肌肉注射与口服甲钴胺对老年维生素B12缺乏患者的疗效观察

目的研究肌肉注射与口服甲钴胺对老年维生素B12缺乏患者血液学指标与神经系统体征的影响。方法将符合入组条件的126例老年维生素B12缺乏患者随机分为肌肉注射组（肌肉注射甲钴胺治疗）、口服组（口服甲钴胺治疗）和对照组（不用甲钴胺治疗）3组,每组42例,比较各组受试者治疗前和治疗6个月后血红蛋白（Hb）、平均红细胞体积（MCV））、血清叶酸、维生素B12、同型半胱氨酸（Hey）浓度及神经系统体征的变化。结果基线状态3组受试者一般情况相似,治疗6个月后,对照组各项指标无明显改变;肌肉注射组血维生素B12由（139．13±31．57）ng／L上升至（328．10±42．35）ng／L（t=23．18,P〈0．001）,Hcy由（36．29±16．23）μmol／L降至（18．23±9．85）μmol／L（t=6．16,P〈0．001）,Hb由（125．34±16．21）g／L升至（132．79±15．98）g/L（t=2．12,P=0．037）,MCV贝0由（92．98±5．35）n降至（87．65±5．74）fl（t=4．40,P〈0．001）,差异均有统计学意义;口服组血维生素B12由（138．19±29．95）ng／L升至（487．79±32．21）ng／L（t=51．51,P〈0．001）,Hey由（33．27±11．51）μmol／L降至（17．49±10．13）μmol／L（t=6．67,P〈0．001）,Hb由（125．89±17．65）g／L升至（133．46±16．26）g／L（t=2．08,P=0．041）,MCV由（93．08±5．10）fl降至（89．29±5．37）fl（t=3．32,P=0．ot31）,差异均有统计学意义。治疗6个月后,肌肉注射组MMSE评分、口服组MMSE评分均较基线时有所提高,但差异均无统计学意义（P值分别为0．633和0．408）;肌肉注射组治疗6个月后跟腱反射（1．86±0．67与1．56±0．61）、口服组治疗6个月后跟腱反射（1．79±0．64与1．43±0．51）均较基线时有所增强（P值分别为0．035和0．006）;肌肉注射组的足部振动觉（1．35±0．37与1．06±0．41）、口服组治疗6个月后足部振动觉（1．244±0．52与1．01±0．43）均较基线时有改善（P值分别为0．001和0．03）,差异均有统计学意义。治疗6个月后,口服组血清维生素B12浓度较肌肉注射组更高（P〈0．001）,其余指标差异均无统计学意义。结论肌肉注射或口服甲钴胺治疗均能改善老年维生素B12缺乏患者的血液学指标和神经系统症状与体征。