Carmel R, Sinow R M, Siegel M E, Samloff I M
Department of Medicine, University of Southern California School of Medicine, Los Angeles 90033.
Arch Intern Med. 1988 Aug;148(8):1715-9.
Malabsorption of food-bound or protein-bound cobalamin with normal absorption of free cobalamin has been described in studies of patients with gastric dysfunction. We used the egg-yolk cobalamin absorption test to study 47 patients selected not because of known gastric disorders but because they had low serum cobalamin levels with normal Schilling test results. Their egg test results were significantly lower than in normal controls, while Schilling test results were normal. Twenty of the subjects had egg test excretion below 1.5%. No features distinguished them from the 27 who excreted more than 1.5% other than the presence of lower pepsinogen I:II ratios. Eight of 19 tested patients with food cobalamin malabsorption had no evidence of abnormal gastric status by blood tests and/or gastric analysis. Also noteworthy was the finding of food cobalamin malabsorption in 60% of tested patients who had neurologic, cerebral, or psychiatric abnormalities. Food cobalamin malabsorption appears to be associated frequently with otherwise unexplained low cobalamin levels. Low cobalamin levels in patients with normal Schilling test results cannot be dismissed as insignificant without also testing for food cobalamin malabsorption, whether or not the patients have known gastric dysfunction.
在胃功能障碍患者的研究中，已描述了食物结合型或蛋白结合型钴胺素吸收不良而游离钴胺素吸收正常的情况。我们使用蛋黄钴胺素吸收试验对47例患者进行研究，这些患者并非因已知胃部疾病入选，而是因为他们血清钴胺素水平低但希林试验结果正常。他们的鸡蛋试验结果显著低于正常对照组，而希林试验结果正常。20名受试者的鸡蛋试验排泄率低于1.5%。除了胃蛋白酶原I:II比值较低外，没有其他特征能将他们与排泄率超过1.5%的27名受试者区分开来。19例经检测的食物钴胺素吸收不良患者中，有8例通过血液检测和/或胃分析没有胃异常的证据。同样值得注意的是，在60%有神经、大脑或精神异常的经检测患者中发现了食物钴胺素吸收不良。食物钴胺素吸收不良似乎经常与其他原因不明的低钴胺素水平相关。对于希林试验结果正常的患者，无论他们是否已知有胃功能障碍，如果不进行食物钴胺素吸收不良检测，就不能将低钴胺素水平视为无足轻重而不予理会。
