Maruyama S, Hirayama C, Yamamoto S, Koda M, Udagawa A, Kadowaki Y, Inoue M, Sagayama A, Umeki K
Department of Internal Medicine, Saiseikai Gotsu General Hospital, Shimane, Japan.
J Lab Clin Med. 2001 Nov;138(5):332-7. doi: 10.1067/mlc.2001.119106.
Macrocytosis is most commonly associated with vitamin B(12) and folic acid deficiency, followed by alcoholism, liver disease, and other pathologic conditions. We studied the red cell and vitamin status in 423 consecutive patients with various liver diseases, including 31 with acute viral hepatitis (AVH), 105 with chronic hepatitis (CH), and 134 with alcoholic liver disease (ALD), who consisted of 84 with non-cirrhotic alcoholic liver disease (NCALD) and 50 with alcoholic liver cirrhosis (ALC), 60 with non-alcoholic liver cirrhosis (NALC), and 93 with hepatocellular carcinoma (HCC). The mean corpuscular volume (MCV) and red cell distribution width (RDW) were significantly higher in patients with ALD and NALC, and among them macrocytosis occurred more frequently in patients with ALC. Macrocytic anemia was mostly found in cirrhotic patients, in which the Child-Pugh score was closely related to the development of macrocytic anemia. In ALD, the MCV was significantly correlated with the estimated alcohol consumption and inversely correlated with the serum folic acid level, which, however, was often maintained within the normal range in patients with macrocytic ALC. After abstinence from alcohol, the MCV and RDW were reduced significantly and were associated with an increasing serum folic acid level. This suggests that macrocytic anemia was a common feature of alcoholic and non-alcoholic liver cirrhosis and that alcohol abuse and folic acid deficiency play a secondary role in macrocytosis.
大细胞性贫血最常与维生素B12和叶酸缺乏相关，其次是酒精中毒、肝脏疾病及其他病理状况。我们研究了423例连续的患有各种肝脏疾病的患者的红细胞及维生素状况，其中包括31例急性病毒性肝炎（AVH）患者、105例慢性肝炎（CH）患者、134例酒精性肝病（ALD）患者（其中84例为非肝硬化酒精性肝病（NCALD），50例为酒精性肝硬化（ALC））、60例非酒精性肝硬化（NALC）患者以及93例肝细胞癌（HCC）患者。ALD和NALC患者的平均红细胞体积（MCV）和红细胞分布宽度（RDW）显著更高，其中大细胞性贫血在ALC患者中更常见。大细胞性贫血多见于肝硬化患者，其中Child-Pugh评分与大细胞性贫血的发生密切相关。在ALD中，MCV与估计的酒精摄入量显著相关，与血清叶酸水平呈负相关，然而，大细胞性ALC患者的血清叶酸水平通常维持在正常范围内。戒酒之后，MCV和RDW显著降低，并与血清叶酸水平升高相关。这表明大细胞性贫血是酒精性和非酒精性肝硬化的一个常见特征，并且酒精滥用和叶酸缺乏在大细胞性贫血中起次要作用。
