Haslam N, Probert C S
University Department of Medicine, Bristol Royal Infirmary, UK.
J R Soc Med. 1998 Feb;91(2):72-3. doi: 10.1177/014107689809100205.
On the suspicion that folate deficiency was not being thoroughly investigated we conducted a retrospective study of management in a teaching hospital. Notes from 84 consecutive patients with low red cell folates (mean age 69.5 years, range 21-95, M:F 33:51) were reviewed for haemoglobin, mean cell volume, dietary history, alcohol consumption, drug history, relevant medical history, relevant investigations, treatment, repeat measurement of red cell folate and diagnosis of deficiency. In 52 (61.9%, mean age 72.9 years, range 33-95, M:F 21:51) no diagnosis was reached. In only 32 (38.1%, mean age 63.9 years, range 21-89, M:F 12:20) was a definitive diagnosis established: 5 had coeliac disease, 1 had Crohn's disease, 9 had drug-associated deficiency (4 methotrexate, 3 phenytoin, 1 trimethoprim and 1 valproate), 1 had combined variable immunodeficiency and 16 had dietary deficiency. In most cases of folic acid deficiency no attempt was made to establish aetiology. We recommend that younger patients without an obvious cause are investigated initially by dietary assessment and measurement of anti-endomysial antibody and by duodenal biopsy with small-bowel follow-through if clinically indicated.
由于怀疑对叶酸缺乏症的调查不够彻底，我们在一家教学医院进行了一项回顾性管理研究。回顾了84例连续红细胞叶酸水平低的患者（平均年龄69.5岁，范围21 - 95岁，男:女为33:51）的病历，以了解血红蛋白、平均红细胞体积、饮食史、饮酒情况、用药史、相关病史、相关检查、治疗、红细胞叶酸重复测量及缺乏症诊断情况。52例（61.9%，平均年龄72.9岁，范围33 - 95岁，男:女为21:51）未得出诊断结果。仅32例（38.1%，平均年龄63.9岁，范围21 - 89岁，男:女为12:20）确诊：5例患有乳糜泻，1例患有克罗恩病，9例患有药物相关缺乏症（4例与甲氨蝶呤有关，3例与苯妥英有关，1例与甲氧苄啶有关，1例与丙戊酸盐有关），1例患有联合可变免疫缺陷，16例患有饮食缺乏症。在大多数叶酸缺乏病例中，未尝试确定病因。我们建议，对于无明显病因的年轻患者，最初应通过饮食评估、抗肌内膜抗体检测进行调查，如有临床指征，还应进行十二指肠活检及小肠造影检查。
