Link H, Blaurock M, Wernet P, Niethammer D, Wilms K, Ostendorf P
Klin Wochenschr. 1986 May 2;64(9):423-32. doi: 10.1007/BF01727528.
After bone marrow transplantation (BMT), megaloblastic bone marrow changes are often observed that can only be partially explained by drug effects. Our goal was to find out whether folic acid deficiency represented an additional factor. The serum folic acid concentrations of 41 patients were determined regularly before and after BMT. A 2nd degree polynomial regression analysis revealed a clear and acute drop in folic acid concentrations within 7-9 days after BMT. In 19 patients the level fell below 3.0 ng/ml, the range of folic acid deficiency. The mean folic acid values without oral administration of folic acid after BMT lay significantly below the mean values with substitution (P less than 0.001). If a case of acute graft versus host disease (GvHD) was more severe than grade I, the mean folic acid levels were significantly lower (P less than 0.01). Patients with megaloblastic bone marrow changes after BMT had significantly lower folic acid values than those without such changes (P less than 0.01). The 18 patients with folic acid deficiency had a significantly higher rate of megaloblasts, binucleate erythropoietic precursors, Howell-Jolly bodies, giant myelocytes, and giant metamyelocytes in bone marrow smears than the remaining 23 patients (P less than 0.05). Folic acid deficiency did not slow down the increase in leukocytes, granulocytes, thrombocytes, or reticulocytes after BMT. There were 8.2%-9.7% hypersegmented neutrophils in the blood (normal 5%) after BMT both with and without folic acid deficiency. Folic acid deficiency after BMT was caused by insufficient intake combined with simultaneous decreased intestinal resorption and increased requirements for the regeneration of bone marrow and intestinal mucosa.
骨髓移植（BMT）后，常观察到巨幼细胞性骨髓改变，而药物作用只能部分解释这些改变。我们的目标是查明叶酸缺乏是否是一个额外因素。对41例患者在BMT前后定期测定血清叶酸浓度。二次多项式回归分析显示，BMT后7 - 9天内叶酸浓度出现明显且急剧下降。19例患者的叶酸水平降至低于3.0 ng/ml，即叶酸缺乏范围。BMT后未口服叶酸时的平均叶酸值显著低于补充叶酸时的平均值（P小于0.001）。如果急性移植物抗宿主病（GvHD）病例比I级严重，则平均叶酸水平显著更低（P小于0.01）。BMT后出现巨幼细胞性骨髓改变的患者叶酸值显著低于未出现此类改变的患者（P小于0.01）。18例叶酸缺乏患者骨髓涂片的巨幼细胞、双核红细胞前体、豪-焦小体、巨大髓细胞和巨大晚幼粒细胞的比例显著高于其余23例患者（P小于0.05）。叶酸缺乏并未减缓BMT后白细胞、粒细胞、血小板或网织红细胞的增加。BMT后，无论有无叶酸缺乏，血液中均有8.2% - 9.7%的中性粒细胞核分叶过多（正常为5%）。BMT后的叶酸缺乏是由于摄入不足，同时肠道吸收减少以及骨髓和肠黏膜再生需求增加所致。
