| Background:Megaloblastic anemia(MA)is a common nutritional anemia in the elderly.In addition to the most common manifestations of anemia,there are digestive system,genitourinary system manifestations,and some neuropsychiatric symptoms.The aging of the population,the elderly digestion ability weakened,sick survival,MA in the elderly population incidence increased trend,especially vitamin B12(referred to as B12)deficiency caused by the elderly MA more and more attention.The purpose of this study is to summarize the clinical features of elderly patients with MA,and to improve the understanding of MA in elderly patients,so as to better prevent and treat the diseaseObjective:By summarizing the clinical characteristics of elderly patients with MA,to improve the understanding of MA,early diagnosis and treatment,to avoid the further development of MA disease.Methods:From January 2012 to April 2017,the department of hematology in nanjing first hospital was diagnosed as MA with 82 elderly patients with a history of history,history and diet.Determination of blood routine,lactate dehydrogenase,indirect bilirubin,urchin,serum folic acid,serum B12,ferritin;The endoscopic examination,helicobacter pylori detection and ultrasonography were performed.Bone marrow cytologic examination and bone marrow iron staining were performed.Results:1.The clinical symptoms of dizziness,fatigue in 74 cases(90.2%),67(81.7%)cases of anorexia,palpitation,chest tightness,25 cases(30.5%)are rare,rare mental disorders and depression in 3 cases(3.7%);76 cases with signs of anemia(92.3%),62 cases of mirror tongue(75.6%)most of the elderly;MA patients with multiple survival,more common in the past history of chronic gastritis in 39 cases(47.6%),37 cases of hypertension(45.1%),hyperlipidemia in 33 cases(40.2%),29 cases of coronary heart disease(35.4%).2.MA anemia degree,the average Hb of 67.42 ± 17.85g/L,MCV ± 19.01fl with an average of 114.89,but with iron deficiency anemia in patients with MCV is normal or reduced;three blood cells decreased in 34 cases(41.5%),three blood cells of MA patients reduce the degree of anemia is more important;we also observed that LDH increased in 74 cases(77.1%),23 cases with elevated IBIL(24%),and Urinary biliary positive in 30 cases(31.3%).3.Gastrointestinal endoscopy and ultrasonography showed that the most common cases were chronic superficial gastritis in 47 cases(74.6%),followed by cholecystitis in 32 cases(39.0%).4.Serum B12 decreased in 57 cases(69.5%)in MA patients,and decreased in 17 cases(20.7%),including simultaneous decrease in 9 cases(11.0%),normal or elevated in 15 cases(18.3%).5.Bone marrow examination showed that the bone marrow showed active hyperplasia of bone marrow or significantly active in 69 cases(97.2%),bone marrow iron stain:extracellular iron(+?+ +)39 cases(54.9%),(+ + +?+ + + +)28 cases(39.4%),(-)4 cases(5.6%),intracellular iron(3%?76%);also found 43 cases of MA patients increased ferritin(52.4%).Conclusion:1.Elderly patients with MA often suffer from multiple system diseases,mainly cardiovascular and nervous system symptoms.2.MCV in patients with MA is generally increased,with other types of anemia except;with blood cell line three reduction in patients with more severe anemia.3.Determination of serum total B12 and folic acid is not the gold standard for the diagnosis of MA in the elderly;MA elderly patients often suffer from hemolysis;and elderly patients have abnormal iron metabolism;patients often suffer from chronic digestive tract diseases.Background:The elderly population is high risk of B12 deficiency,especially in elderly patients with malabsorption B12 diseases such as CAG,B12 levels decreased with the increase of age,B12 deficiency can cause widespread disease system,causing great harm to the health of the elderly,the lack of clinical early detection is crucial.The B12 was significantly decreased in elderly patients with clinical symptoms and is easily diagnosed clinically,but in the community,there are more elderly patients with no obvious clinical manifestations of subclinical B12 deficiency or accompanied by clinical symptoms but B12 in the normal range,the diagnosis is more difficult,the total serum B12 level may not always reflect the actual situation accurately B12 that result in misdiagnosis.It is important to find B12 deficiency in such populations and to prevent further deterioration of B12 deficiency.The absence of occult B12 showed no clinical specificity,or laboratory B12 was normal.Therefore,B12 lack of diagnostic laboratory metabolites of methylmalonic acid(MMA),homocysteine(Hcy)and holotranscobalamin(HoloTC)diagnosis of B12 deficiency is more accurate.This study mainly explored the correlation between MMA,Hcy,HoloTC and B12 levels in MA group,CAG group and control group,and evaluated the diagnostic value and diagnostic efficacy of the three on B12 deficiencyObjective:1.To investigate the occurrence of B12 deficiency in the control group and the CAG group.2.Compare the levels of B12,MMA,Hcy and HoloTC in MA group,CAG group and control group.3.Objective to explore the correlation between serum MMA,Hey,HoloTC and serum B12,to explore the predictive value of MMA,Hcy and HoloTC in the diagnosis of B12 deficiency,and to evaluate the diagnostic efficacy of the three on B12 deficiency.Methods:Disease group:Group MA was selected from March 2016 to July 2016 in Nanjing First Hospital Department of Hematology diagnosed MA hospitalized patients in 10 cases;group CAG was the same period gastroenterology department CAG hospitalized patients 28 cases;our hospital physical examination center screening of healthy elderly 50 cases as control group.Patients with MA patients and CAG patients were taken into the hospital for the second day of the hospital.After centrifugation,serum was extracted to detect B12 and folate concentration by chemiluminescence,and the concentration of MMA,Hey and HoloTC was detected by ELISA.Using SPSS21.0 statistical analysis software to input and input data.P<0.05 was considered to be statistically significant.Results:1.There was no significant difference in the incidence of folic acid deficiency between group MA,group CAG and control group.There was no significant difference between the three groups in folic acid concentration(P>0.05).2.The lack of B12 in MA group was significantly higher than the control group(P<0.001).The incidence of CAG group and control group B12 deficiency,no significant difference(P>0.05);MA B12 group was significantly lower than that in control group,the difference was statistically significant(P<0.001);CAG group B12 and control group in the serum concentration of B12,no significant difference(P>0.05).3.The average concentration of MMA in group MA was 732.47±53.62ng/ml,which was the highest in the three groups,the difference was statistically significant(P<0.001);followed by CAG group,the concentration of MMA was 652.61±128.20ng/ml,higher than that of the control group,the difference was statistically significant(P<0.05)4.The average concentration of Hey in group MA was 15.21 ± 1.91umol/L,the highest in the three groups,the difference was statistically significant(P<0.001);followed by CAG group,the concentration of Hey was 10.46±2.67umol/L,higher than that of the control group,the difference was statistically significant(P<0.05).5.The average HoloTC concentration of MA group was 25.02±8.13ng/ml,which was the lowest in the three groups,the difference was statistically significant(P<0.05);CAG group HoloTC compared with the control group,the difference was not statistically significant(P>0.05).6.The total B12 serum MA concentration was negatively correlated with serum concentration of MMA(r=-0.699,P=0.025),and negatively correlated with the serum concentration of Hey(r=-0.641,P=0.046),and serum HoloTC concentration was positively correlated(r=0.646,P=0.044);group CAG serum total B,2 concentration was negatively correlated with serum concentration of MMA(r=-0.432 P=0.022).A negative correlation with serum Hey concentration(r=-0.425,P=0.025),and serum HoloTC concentration was positively correlated(r=0.393,P=0.038);control group serum B12 concentration and serum MMA concentration was negatively correlated(r=-0.289,P=0.042),and negatively correlated with the serum concentration of Hey(r=-0.315,P=0.026),and serum HoloTC concentration was positively correlated(r=0.280,P=0.049,Hey and MMA);folic acid and HoloTC have no significant correlation;control group MMA and HoloTC were negatively correlated(r=-0.210,P<0.05);CAG was negatively related to group MMA and HoloTC(r=-0.301,P<0 5)there were correlations between the three metabolites and B12-In group MA,the correlation between B12 and metabolites was the largest,followed by group CAG.7.In group MA,MMA,Hey,HoloTC predictive value was not significant(P>0.05);in group CAG,MMA OR 0.986(P =0.032),Hey OR 0.703(P =0.075);HoloTC OR(P =0.040)value of 1.206,Hey had no predictive value significantly in the CAG group the absence of B12;in the control group,MMA OR 0.990(P =0.006),Hey OR 0.787(P =0.017),HoloTC OR 1.199(P =0.004);MMA,Hey and HoloTC in the diagnosis of group B12 deficiency is the predictive value,three metabolites and B12 deficiency independently associated with HoloTC OR value the most,followed by MMA,the lowest Hey.8.The control group in the diagnosis of B12 deficiency,MMA,Hey and HoloTC area under the curve(The area under the cure,AUC)were 0.749(P<0.001)and 0.663(P<0.05)and 0.754(P<0.001);three metabolite cutoff value,sensitivity,specificity,665.80ng/ml 71.5%,75%,12.43umol/l,75%,57.9%,70.8%,73.7%and 29.81ng/ml;in group CAG,diagnosis of the absence of B12,MMA,Hey and HoloTC AUC were 0.731(P<0.05)and 0.689(P<0.05)and 0.765(P<0.05);three metabolite cutoff value,sensitivity,specificity were 651.505ng/ml,77.9%,69%,10.765umol/l,71.4%,66.7%,78.6%and 28.48ng/ml,64.3%;HoloTC in the diagnosis of the absence of B12 AUC is the largest,followed by MMA,Hey is the lowest,but the sensitivity and specificity of the three metabolites in the diagnosis of B12 deficiency are not high.Conclusion:1.The three groups in group MA B12 deficiency was the highest,while the CAG group and the control group without B12 there was no significant difference between the MA group;as compared with the control group,B12 and HoloTC concentration decreased,MMA,Hey concentration increased;CAG group compared with the control group,no significant difference between the B12 and HoloTC concentration MMA,and the concentration of Hey increased.2.Serum B12 concentration was negatively correlated with the concentration of MMA and Hey,and positively correlated with HoloTC.3.MMA,Hey and HoloTC have certain diagnostic value for B12 deficiency.HoloTC has the greatest diagnostic value,followed by MMA,and Hey has the least diagnostic value. |
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