Stabler S P, Marcell P D, Podell E R, Allen R H, Savage D G, Lindenbaum J
Division of Hematology, University of Colorado Health Sciences Center, Denver 80262.
J Clin Invest. 1988 Feb;81(2):466-74. doi: 10.1172/JCI113343.
To determine if levels of serum total homocysteine are elevated in patients with either cobalamin or folate deficiency, we utilized a new capillary gas chromatographic-mass spectrometric technique to measure total homocysteine in the serum of 78 patients with clinically confirmed cobalamin deficiency and 19 patients with clinically confirmed folate deficiency. Values ranged from 11 to 476 mumol/liter in the cobalamin-deficient patients and 77 of the 78 patients had values above the normal range of 7-22 mumol/liter as determined for 50 normal blood donors. In the cobalamin-deficient patients, serum total homocysteine was positively correlated with serum folate, mean corpuscular volume, serum lactate dehydrogenase, serum methylmalonic acid, and the degree of neurologic involvement, and inversely correlated with platelets and hematocrit. In the folate-deficient patients, values for serum total homocysteine ranged from 17 to 185 mumol/liter and 18 of the 19 patients had values above the normal range. Some patients with pernicious anemia who were intermittently treated with cyanocobalamin were found to have elevated serum levels of total homocysteine while they were free of hematologic and neurologic abnormalities. The measurement of serum total homocysteine will help define the incidence of cobalamin deficiency and folate deficiency in various patient populations.
为了确定钴胺素或叶酸缺乏患者的血清总同型半胱氨酸水平是否升高，我们采用一种新的毛细管气相色谱 - 质谱技术，测量了78例临床确诊的钴胺素缺乏患者和19例临床确诊的叶酸缺乏患者血清中的总同型半胱氨酸。钴胺素缺乏患者的值在11至476μmol/升之间，78例患者中有77例的值高于为50名正常献血者测定的7 - 22μmol/升的正常范围。在钴胺素缺乏患者中，血清总同型半胱氨酸与血清叶酸、平均红细胞体积、血清乳酸脱氢酶、血清甲基丙二酸以及神经受累程度呈正相关，与血小板和血细胞比容呈负相关。在叶酸缺乏患者中，血清总同型半胱氨酸值在17至185μmol/升之间，19例患者中有18例的值高于正常范围。一些间歇性接受氰钴胺治疗的恶性贫血患者，在没有血液学和神经学异常时，发现其血清总同型半胱氨酸水平升高。血清总同型半胱氨酸的测量将有助于确定不同患者群体中钴胺素缺乏和叶酸缺乏的发生率。
