Savage D, Lindenbaum J
Am J Med. 1983 May;74(5):765-72. doi: 10.1016/0002-9343(83)91064-1.
One or more episodes of recurrent megaloblastic anemia occurred in 36 (10.8 percent) of 333 patients with pernicious anemia following interruption of therapy. Treatment had most commonly been discontinued by patients because they felt well, or by physicians due to error. Thirty-five episodes of recurrent cobalamin deficiency were analyzed in detail. In the 24 patients in whom the exact date of cessation of therapy was recorded, the mean interval before relapse was diagnosed was 64.5 months (range 21 to 123 months). Recurrence manifested as macrocytosis in the absence of anemia occurred earlier (mean, 49.2 months) than that associated with anemia (73.1 months). A weak correlation was apparent between the amount of previous cyanocobalamin treatment and time to relapse. One third of relapses were unrecognized and left untreated for more than two years, while usually slow hematologic progression occurred. Recurrences of cobalamin deficiency in individual patients exhibited mimetic features. Further study is necessary to establish the optimal dosage and frequency of maintenance therapy in pernicious anemia.
在333例恶性贫血患者中，有36例（10.8%）在治疗中断后出现了一次或多次复发性巨幼细胞贫血发作。治疗最常见的中断原因是患者感觉良好自行停药，或医生因失误停药。对35次复发性钴胺素缺乏发作进行了详细分析。在记录了确切停药日期的24例患者中，复发被诊断前的平均间隔时间为64.5个月（范围21至123个月）。无贫血情况下以大细胞性表现的复发出现得更早（平均49.2个月），比伴有贫血的复发（73.1个月）更早。先前氰钴胺治疗的剂量与复发时间之间存在微弱的相关性。三分之一的复发未被识别，且未治疗超过两年，同时通常发生缓慢的血液学进展。个体患者的钴胺素缺乏复发表现出模拟特征。有必要进一步研究以确定恶性贫血维持治疗的最佳剂量和频率。
