Airoldi M, Fantasia R, Aloigi-Luzzi D, Stefanetti C, Deserò D, Chiodini E, Gobbi A
Minerva Med. 1987 Jun 15;78(11):739-43.
The figures obtained in simultaneous radioimmunological assays of serum folate and vitamin B12 concentrations and erythrocyte folate concentration in 74 patients are presented. All these patients had a regular daily intake of over 80 g ethyl alcohol and presented an increase in mean blood cell volume. Most of the patients were males hospitalised with liver disease and/or anaemia. All were given bone narrow needle aspirations and liver biopsies. 46% of the patients presented a reduction in erythrocyte folates but vitamin B12 deficiency was rarely encountered. Megaloblastic transformation of the bone narrow was present in 56% of the alcoholics with reduced erythrocyte folates and in 10% of those with normal folate concentration. No correlation was found between serum and erythrocyte folate concentration and degree of liver damage. Serum vitamin B12 levels were higher in patients with cirrhosis. Inadequate diet was frequently found in the alcoholics with reduced folate concentrations. Due to variations in patient selection it is difficult to compare these data with those of other series but they do seem to confirm the hypothesis that the macrocytosis in most "healthy" alcoholics reflects a direct toxic action of the alcohol on erythropoiesis. In contrast folate deficiency is found among "derelict" chronic alcoholics in whom the vitamin deficiency has often not yet produced megaloblastosis of the bone marrow.
本文呈现了对74例患者血清叶酸、维生素B12浓度及红细胞叶酸浓度进行同步放射免疫分析所获得的数据。所有这些患者每日乙醇摄入量均超过80克，且平均血细胞体积增大。大多数患者为因肝病和/或贫血住院的男性。所有患者均接受了骨髓穿刺和肝活检。46%的患者红细胞叶酸减少，但维生素B12缺乏很少见。红细胞叶酸减少的酗酒者中56%存在骨髓巨幼样变，叶酸浓度正常者中10%存在骨髓巨幼样变。血清和红细胞叶酸浓度与肝损伤程度之间未发现相关性。肝硬化患者血清维生素B12水平较高。叶酸浓度降低的酗酒者常存在饮食不足。由于患者选择存在差异，难以将这些数据与其他系列的数据进行比较，但它们似乎确实证实了这样一种假设，即大多数“健康”酗酒者的大细胞性贫血反映了酒精对红细胞生成的直接毒性作用。相比之下，在“流浪”慢性酗酒者中发现叶酸缺乏，这些酗酒者的维生素缺乏往往尚未导致骨髓巨幼细胞性贫血。
