血浆同型半胱氨酸的表达及变化在不同病因大细胞贫血患者中的鉴别及治疗意义

目的 比较不同病因大细胞贫血患者血浆同型半胱氨酸(HCY)、叶酸及维生素B12的水平及治疗前后的动态变化,探讨其在鉴别诊断及治疗中的意义.方法 测定HCY、叶酸、维生素B12水平使用电化学发光免疫法.全血细胞分析计数采用激光流式细胞检测法(光学法)及电阻抗法.结果 营养性巨幼细胞贫血患者HCY为(71.26±27.84)μmol/L,较药物性巨幼细胞贫血(11.44±5.06)μmol/L、骨髓增生异常综合征(9.51±4.13)μmol/L及健康对照组(8.74±5.42)μmoL/L均明显升高(P均<0.01);小剂量叶酸、维生素B12治疗后营养性巨幼细胞贫血患者HCY水平可以恢复至正常,但较大剂量组恢复时间延迟.结论 血浆HCY的水平在不同病因大细胞贫血中具有鉴别意义,其恢复时间与应用叶酸及维生素B12剂量相关.

The serum homocysteine levels and dynamic changes in patients with different etiologic macrocytic anemia

Objective To examine the serum homocysteine,folic acid and Vitamin B12 levels in macrocytic anemia patients and observe their dynamic changes following therapy. Methods Homocysteine,folic acid and Vita-min B12 were analyzed by electro-chemiluminescence immunoassay. Complete blood cell count was analyzed by opti-cal method and resistance method. Results The homocysteine is significantly higher in nutritional megaloblastic a-nemia[ (71.26±27.84)μmoL/L ] than in drug-induced megaloblastic anemia[(11.44±5.06)μmol/L],in myel-odysplastic syndrome[ (9.51±4.13)μmol/L] and in the normal control group[(8.74±5.42)μmoL/L] (P<0.01). After treated with low-dosage folic acid and Vitamin B12,the patients with megaloblastic anemia presented slow declining but eventually normal homocysteine levels,compared with those received high-dosages. Conclusion Homocysteine can be used for differential diagnosis of macrocytic anemia. The duration of remaining of abnormal ho-mecysteine levels is related to the dosage of folic acid and Vitamin B12.