International Neurologic & Psychiatric Epidemiology Program, Department of Neurology & Ophthalmology, Michigan State University, 909 Fee Road, W Fee Hall Room 324, East Lansing, MI 48824, USA; University of Zambia, Department of Medicine, Nationalist Road, P.O. Box 50101, Lusaka, Zambia.
Tropical Gastroenterology and Nutrition Group, University of Zambia, Department of Medicine, P.O. Box 50398, Lusaka, Zambia.
J Neurol Sci. 2020 Feb 15;409:116583. doi: 10.1016/j.jns.2019.116583. Epub 2019 Nov 20.
To evaluate the odds of vitamin B12 and folate deficiencies among Zambian clinic attendees with distal symmetric polyneuropathy (DSP) and age, sex, and HIV matched controls.
Cases were adults from clinics in urban/peri-urban Zambia. Controls were enrolled among persons not seeking personal medical care, such as a caregiver or person collecting antiretrovirals without a medical complaint. Participants underwent structured interviews, physician examination, and assessments of complete blood count, renal and liver profiles, serum vitamin B12 and folate, erythrocyte folate, plasma total homocysteine and methylmalonic acid. HIV testing and CD4 counts were performed when appropriate.
Among 107 consenting matched case-control pairs, 65% were female, 52% HIV positive, with mean age of 47.6 (SD 13.5) years. Among HIV positive participants, mean CD4 count was 484 (SD 221) and 482 (SD 236) for cases and controls, respectively (p = .93). DSP symptoms and severity did not differ by HIV status (p's > 0.05). Height, history of tuberculosis treatment, alcohol use, education, asset index, dietary diversity, and nutritional supplement use did not differ between cases and controls (p's > 0.05). DSP cases had at least 3:1 odds of having low serum folate (p = .0001), severely low erythrocyte folate (p = .014), and elevated total homocysteine (p = .001) levels compared to controls. Markers of vitamin B12 deficiency were not associated with case status (p's > 0.05).
Markers of folate deficiency are highly associated with DSP among Zambian clinic attendees. Future studies should consider a broader range of comorbid nutritional deficiencies, and strategies for interventions.
评估赞比亚出现远端对称性多发性神经病（DSP）的就诊患者与年龄、性别和 HIV 相匹配的对照者中维生素 B12 和叶酸缺乏的几率。
病例为赞比亚城乡诊所的成年人。对照者招募自未寻求个人医疗护理的人群，如无医疗投诉的照顾者或领取抗逆转录病毒药物的人。参与者接受了结构化访谈、医生检查以及全血细胞计数、肾功能和肝功能检查、血清维生素 B12 和叶酸、红细胞叶酸、血浆总同型半胱氨酸和甲基丙二酸的评估。在适当情况下进行了 HIV 检测和 CD4 计数。
在 107 名同意的匹配病例对照者中，65%为女性，52%为 HIV 阳性，平均年龄为 47.6（SD 13.5）岁。在 HIV 阳性参与者中，病例和对照者的平均 CD4 计数分别为 484（SD 221）和 482（SD 236）（p=0.93）。DSP 症状和严重程度与 HIV 状态无关（p 值>0.05）。身高、结核病治疗史、饮酒、教育、资产指数、饮食多样性和营养补充剂使用在病例和对照者之间无差异（p 值>0.05）。与对照组相比，DSP 病例至少有 3:1 的可能性出现血清叶酸水平低（p=0.0001）、严重红细胞叶酸水平低（p=0.014）和总同型半胱氨酸水平升高（p=0.001）。维生素 B12 缺乏的标志物与病例状态无关（p 值>0.05）。
在赞比亚就诊患者中，叶酸缺乏的标志物与 DSP 高度相关。未来的研究应考虑更广泛的合并营养缺乏症，并考虑干预措施的策略。
