FOOD COBALAMIN MALABSORPTION OCCURS FREQUENTLY IN PATIENTS WITH UNEXPLAINED LOW SERUM COBALAMIN LEVELS
FOOD COBALAMIN MALABSORPTION OCCURS FREQUENTLY IN PATIENTS WITH UNEXPLAINED LOW SERUM COBALAMIN LEVELS
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DOI：
10.1001/archinte.148.8.1715
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发表时间：
1988-08-01
影响因子：
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通讯作者：
SAMLOFF, IM
中科院分区：
文献类型：
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作者：
CARMEL, R;SINOW, RM;SAMLOFF, IM
在对胃功能障碍患者的研究中已经描述了食物结合或蛋白质结合的钴胺素吸收不良，而游离钴胺素的吸收正常。我们使用蛋黄钴胺素吸收试验对 47 名患者进行了研究，这些患者的选择不是因为已知的胃部疾病，而是因为他们的血清钴胺素水平较低，而席林试验结果正常。他们的鸡蛋测试结果明显低于正常对照，而席林测试结果则正常。 20 名受试者的卵子测试排泄率低于 1.5%。除了胃蛋白酶原 I:II 比例较低之外，没有任何特征可以将他们与排泄量超过 1.5% 的 27 人区分开来。 19 名接受食物钴胺素吸收不良的患者中，有 8 名通过血液检查和/或胃分析未发现胃部状态异常的证据。同样值得注意的是，在患有神经、脑或精神异常的测试患者中，60% 的人发现食物中钴胺素吸收不良。食物钴胺素吸收不良似乎经常与无法解释的低钴胺素水平有关。席林试验结果正常的患者中钴胺素水平较低，如果不进行食物钴胺素吸收不良检测，则不能认为其含量低，无论患者是否患有已知的胃功能障碍。
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, wheter or not the patients have known gastric dysfunction.