老年与青少年巨幼细胞性贫血的临床特点比较

目的探讨老年与青少年巨幼细胞性贫血的临床特点。方法选择129例巨幼细胞性贫血患者,分为老年组(n=83)和青少年组(n=46),分析两组患者贫血的原因和误诊情况。比较骨髓象、外周血象等检查资料。结果老年和青少年患者贫血原因中均以摄入不足比率最高(老年31例,37.35%;青少年29例,63.04%)。老年患者的骨髓象以活跃、明显活跃的比率较高,而青少年患者以极度活跃和明显活跃为主。老年组患者外周血的血红蛋白、白细胞、血小板水平均显著低于青少年组,全血细胞减少患者比率显著高于青少年组(P均0.05)。老年患者中误诊27例,误诊率为32.53%,显著高于青年组的6.52%。两组治疗后血常规均回复正常,但老年组患者的血红蛋白水平恢复正常的时间(29.3±3.8 d)显著长于青少年组(19.9±2.1 d)。结论老年巨幼细胞性贫血患者因临床症状非特异而易误诊,其主要病因在于维生素B12、叶酸的摄入不足,表现为全血细胞水平下降者的比率更高,临床上需要积极掌握老年巨幼细胞性贫血临床特点,对降低误诊率、提高治愈率具有重要意义。

A comparative study on clinieal features of megaloblastic anemia in elderly and young patients.

Objective To explore the clinical features of elderly and young patients with megaloblastic anemia. Methods A total of 129 cases of megaloblastic anemia were collected and divided into elderly group （ n = 83 ） and young group （ n = 46 ）. The causes of anemia and misdi- agnostic rate were analyzed. Bone marrow examination, peripheral blood count and other tests available were compared. Results The causes of a- nemia in elderly patients were due to inadequate intake with the highest proportion （31 cases, 37.35% ） . The proferation of bone marrow cells in elderly patients was active to significantly active, but in young group, it was mainly active to extremely active. Peripheral blood hemoglobin level, count of white blood ceils and platelets in elderly patients were significantly lower than those of young group, and the occurrence of pancytopenia was significantly higher than that of young group （ P 〈 0.05 ） . In elderly patients, 27 cases were misdiagnosed and the misdiagnostic rate reached 32.53% （27/83） , it was significantly higher than that （6.52% , 3/46） of young group. After treatment, level of hemoglobin in 2 groups re- turned to normal, but hemoglobin level in elderly group returned to normal in 29.3 ± 3.8 days after treatment, and it was significantly longer than that （ 19.9 ± 2.1 days） of young group. Conclusion In elderly patients with megaloblastic anemia, their clinical features were usually non - spe- cific, theyrefore they were easily to be misdiagnosed, and their main cause was due to lack of intake of vitamin B12 and folie acid. They usually showed a higher percentage of reduction in whole blood cell count. It is important to actively master the clinical features of elderly patients with megaloblastic anemia in order to reduce the misdiagnostic rate and raise the cure rate.