神经科住院患者维生素B_(12)缺乏调查分析

Analysis of cobalamin deficiency in neurological inpatients

目的了解神经科住院患者中维生素B12缺乏的状况,评估50岁以上神经科住院患者常规检测维生素B12水平的必要性。方法受调查人群为中国医科大学附属盛京医院神经内科2008年8月～2009年8月期间住院患者,年龄>50岁,无严重肝肾功能障碍,入院前3个月未使用维生素B12制剂,检测血清叶酸、维生素B12、同型半胱氨酸等指标。同时对维生素B12缺乏患者进行神经系统评估。结果发现维生素B12缺乏者158例,50岁以上维生素B12缺乏发生率为16.2%,60岁以上维生素B12缺乏发生率为15.5%。70岁以上维生素B12缺乏发生率为18.9%。80岁以上维生素B12缺乏发生率为24.6%。维生素B12缺乏的神经系统表现在60.8%病例中出现,最常见的神经系统表现为下肢的振动觉下降,发生率为50.6%,除外糖尿病患者,22.8%的维生素B12缺乏者存在周围神经病。确诊为脊髓亚急性联合变性仅10例,占6.3%。结论维生素B12缺乏好发于中老年人,最常见的神经系统表现为下肢的振动觉下降,感觉性神经病也很常见。建议对于神经科就诊的50岁以上患者,常规检查血清叶酸、B12水平。

【Objective】 To investigate the situation of the cobalamin deficiency（Cbl） in the neurological inpatients in order to assess the necessity for routine examination of Cbl in patients above 50 years.【Methods】 The surveyed population consisted of 978 inpatients in the Department of Neurology in Shengjing Hospital of China Medical University during the period from September 2008 to August 2009.Subjects were eligible for the study if they were over 50 years old without severe liver dysfunction,and had not received parenteral Cbl or 100 μg oral Cbl daily during the 3 months prior to the study.Serum foliate,cobalamin and homocysteine concentration was determined in blood samples obtained on entry into the study.Subjects were considered Cbl deficiency when their Cbl concentration was 180 pg/mL or plasma homocysteine concentration was 15 μmol/L.And then the Cbl deficient patients and non-deficient controls underwent a detailed neurological evaluation.【Results】 The total incidence of Cbl deficiency in 978 patients was 16.2%,among which the incidence of Cbl deficiency in patients over 50,60,70 and 80 years was 16.2%,15.5%,18.9%,24.6%,separately.Neurological complications were found in 60.8% of Cbl deficient patients.Diminished vibratory sensation was the most common neurological impairment.When subjects with diabetes mellitus（DM） were excluded,36 patients（22.8%） and 22 controls（11.0%） were found to have mild sensory neuropathy（SN）.Only 10 patients（6.3%） were diagnosed as subacute combined degeneration（SCD） of spinal cord.【Conclusions】 Cbl deficiency is relatively common,especially in the elderly population.The decreased vibratory sensation is a frequent neurological finding in the elderly but is remarkably more in patients with Cbl deficiency.And mild SN is the main neurological impairment.It is recommended for the routine examination of Cbl and foliate concentration in the neurological inpatients above 50 years.