瑞士健康老年人的维生素B12和叶酸水平：一项评估参考区间和决定限的前瞻性研究

Vitamin B12 and folate levels in healthy Swiss senior citizens: a prospective study evaluating reference intervals and decision limits.

作者信息

Risch Martin, Meier Dominik W, Sakem Benjamin, Medina Escobar Pedro, Risch Corina, Nydegger Urs, Risch Lorenz

机构信息

Kantonsspital Graubünden, Zentrallabor, Loësstrasse 170, Chur, 7000, Switzerland.

Labormedizinisches Zentrum Dr. Risch, Waldeggstrasse 37, Liebefeld, 3097, Switzerland.

出版信息

BMC Geriatr. 2015 Jul 11;15:82. doi: 10.1186/s12877-015-0060-x.

DOI:10.1186/s12877-015-0060-x

PMID:26163013

原文链接:https://pmc.ncbi.nlm.nih.gov/articles/PMC4499201/

Abstract

BACKGROUND

The vitamin B12 and folate status in nonanaemic healthy older persons needs attention the more so as decrease in levels may be anticipated from reduced haematinic provision and/or impaired intestinal uptake.

METHODS

A total of 1143 subjectively healthy Swiss midlands participants (637 females and 506 males), ≥60 years of age were included in this study. Levels of vitamin B12, holotranscobalamin (holoTC), methylmalonic acid (MMA), homocysteine (Hcy), serum folate, red blood cell (RBC) folate were measured. Further, Fedosov's wellness score was determined. Associations of age, gender, and cystatin C/creatinine-based estimated kidney function, with the investigated parameters were assessed. Reference intervals were calculated. Further, ROC analysis was done to assess accuracy of the individual parameters in recognizing a deficient vitamin B12 status. Finally, decision limits for sensitive, specific and optimal recognition of vitamin B12 status with individual parameters were derived.

RESULTS

Three age groups: 60-69, 70-79 and ≥ 80 had median B12 (pmol/L) levels of 237, 228 and 231 respectively (p = 0.22), holoTC (pmol/L) of 52, 546 and 52 (p = 0.60) but Hcy (μmol/L) 12, 15 and 16 (p < 0.001), MMA (nmol/L) 207, 221 and 244 (p < 0.001). Hcy and MMA (both p < 0.001), but not holoTC (p = 0.12) and vitamin B12 (p = 0.44) were found to be affected by kidney function. In a linear regression model Fedosov's wellness score was independently associated with kidney function (p < 0.001) but not with age. Total serum folate and red blood cell (RBC) folate drift apart with increasing age: whereas the former decreases (p = 0.01) RBC folate remains in the same bandwidth across all age groups (p = 0.12) A common reference interval combining age and gender strata can be obtained for vitamin B12 and holoTC, whereas a more differentiated approach seems warranted for serum folate and RBC folate.

CONCLUSION

Whereas the vitamin B12 and holoTC levels remain steady after 60 years of age, we observed a significant increment in MMA levels accompanied by increments in Hcy; this is better explained by age-related reduced kidney function than by vitamin B12 insufficiency. Total serum folate levels but not RBC folate levels decreased with progressing age.

摘要

背景

非贫血健康老年人的维生素B12和叶酸状况需要更多关注，因为预计随着血红素供应减少和/或肠道吸收受损，其水平可能会下降。

方法

本研究纳入了1143名主观健康的瑞士中部参与者（637名女性和506名男性），年龄≥60岁。测量了维生素B12、全转钴胺素（holoTC）、甲基丙二酸（MMA）、同型半胱氨酸（Hcy）、血清叶酸、红细胞（RBC）叶酸水平。此外，还确定了费多索夫健康评分。评估了年龄、性别以及基于胱抑素C/肌酐的估计肾功能与研究参数之间的关联。计算了参考区间。此外，进行了ROC分析以评估各个参数在识别维生素B12缺乏状态时的准确性。最后，得出了使用各个参数对维生素B12状态进行敏感、特异和最佳识别的决策限。

结果

三个年龄组：60 - 69岁、70 - 79岁和≥80岁，其维生素B12（pmol/L）水平中位数分别为237、228和231（p = 0.22），holoTC（pmol/L）为52、546和52（p = 0.60），但Hcy（μmol/L）分别为12、15和16（p < 0.001），MMA（nmol/L）分别为207、221和244（p < 0.001）。发现Hcy和MMA（均p < 0.001）受肾功能影响，但holoTC（p = 0.12）和维生素B12（p = 0.44）不受影响。在一个线性回归模型中，费多索夫健康评分与肾功能独立相关（p < 0.001），但与年龄无关。总血清叶酸和红细胞（RBC）叶酸随年龄增长而出现差异：前者下降（p = 0.01），而RBC叶酸在所有年龄组中保持在相同范围内（p = 0.12）。可以获得结合年龄和性别分层的维生素B12和holoTC的通用参考区间，而对于血清叶酸和RBC叶酸，似乎需要更具区分性的方法。