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。

Effects of intramuscular and oral mecobalamin in elderly patients with vitamin B12 deficiency

Objective To investigate the effect of intramuscular and oral mecobalamin on hematologic markers and neurologic signs in elderly patients with vitamin B12 deficiency. Methods One hundred and twenty-six patients with vitamin B12 deficiency who fulfilled the inclusion criteria were randomly divided into 3 groups,42 cases in each,including the intramuscular group （to receive mecobalamin therapy intramuscularly）, the oral group （to receive mecobalamin therapy orally） and the control group （without mecobalamin therapy） The changes of hematologic markers including hemoglobin （ Hb, g/L）, mean corpuscular volume （ MCV, t） ,serum levels of vitamin B12 （ng/L）, folate and total homocysteine （Hcy, μmo]/L）, and neurological signs before and after treatment were compared among these groups. Results Baseline eharacteristics among the three groups were similar. After a 6-month therapy, there were no differences in any markers in control group patients in comparison to baseline;for patients in the intramuscular group, the blood vitamin B12 levels increased from （139. 13±31.57）ng/L to （328.10±42. 35）ng/L （P 〈0. 001）. Hey levels decreased from （36. 29±16. 23）μmol/L to （ 18.23±9.85）μmol/L （ P 〈 0. 0131 ）. Hb rose from （ 125.34±16. 21 ） g/L to （ 132.79±15.98） g/L （ P = 0. 037 ）. MCV reduced from （ 92. 98±5.35 ） fl to （ 87.65±5.74 ） fl （ P 〈 0. 001 ） ; For patients in the oral administration group,the blood vitamin B12 levels increased from （138. 19±29. 95 ）ng/L to （487. 79±32. 21 ） ng/L （P 〈 0. 001 ）. Hey levels decreased from （ 33.27±11.51 ）μmol/L to （ 17.49±0. 13 ）μmol/L （ P 〈 O. 001 ）. Hb rose from （ 125.89±17. 65 ） g/L to （ 133.46±16. 26 ） g/L （ P = 0. 041 ）. MCV reduced from （93.08± 5. 10 ） fl to （ 89. 29±5.37 ） fl （ P = 0. 001 ）. Mter the 6-month therapy, there were somewhat improvement in MMSE scores of the intramuscular （28. 24±3.89 vs. 27. 85±3.56, P = O. 633 ） and the oral groups （27. 97±3.77 vs. 27.34±3.15, P = 0. 408 ） compared with baseline, but the differences were not significant. The achilles tendon reflex of the intramuscular （ 1.86±O. 67 vs. 1.56±0. 61 ,P = 0. 035 ） and the oral groups （ 1.79±O. 64 vs. 1.43±0. 51, P = O. 006 ） were enhanced compared with baseline. Foot vibration sensation of the intramuscular （ 1.35±0. 37 vs. 1.06±0. 41, P = 0. 001 ） and the oral groups （ 1.24±O. 52 vs.l. O1±0.43, P = 0.03） were improved compared with baseline. Mter treatment, the serum VitB12 concentration in the oral group were higher than that of the intramuscular group （ P 〈 O. 001 ）. There were no significant differences in other indexes between the two groups. Conclusion Mecobalamin, administered either intramuscularly or orally, may improve the hematologic markers and neurologie signs in elderly patients with vitamin B12 deficiency.