维生素B12缺乏与神经系统疾病.pptxVIP

;Dr George Hoyt Whipple;罗伯特·伯恩斯·伍德沃德;目 录;维生素B12;维生素B12;代 谢;代 谢;生理作用;生理作用;生理作用;目录;维生素B12缺乏;维生素B12缺乏—传统观点;维生素B12缺乏的现状;维生素B12缺乏的患病率;不同年龄人群维生素B12缺乏的患病率;不同年龄组患者维生素B12水平(pg/ml);目录;维生素B12缺乏的原因;危险人群;目录;用于诊断维生素B12缺乏的检测指标;维生素B12缺乏不同阶段的检测;维生素B12缺乏患者的血液学检查;维生素B12缺乏患者的电生理检查;目录;VitB12缺乏的临床表现;B12缺乏/HHcy所致主要临床症状（1）;B12缺乏/HHcy所致主要临床症状（2）;合并慢性疾病状况 ;脊髓亚急性联合变性（ subacute combined degeneration of the spinal cord，SCD）;SCD病因和病理;SCD影像学特点;第三十五页，共六十页。;SCD临床特点;SCD临床特点;我国SCD不同于国外临床特点： ①发病年龄偏低，多在60 岁以前发病。 ②男性发病明显多于女性。 ③伴发恶性贫血的比例低于国外报道。 ④电生理检查结果特异性不高。;男，62岁. 有萎缩性胃炎。 恶性贫血MCV103，严重脊髓病。 B12缺乏147 pg/mL (186-687 pg/mL)， B12治疗后临床及MRI好转。;第四十页，共六十页。;病 例 2;第四十二页，共六十页。;Learning points;病 例 3;第四十五页，共六十页。;PRACTICE POINTS;对B12缺乏所致神经疾病的新认识;J. Nutr. 137: 1789–1794, 2007.;Of 24 studies that met eligibility criteria, 16 were determined to be of fair quality. Studies did not reveal an association of vitamin B-6 and vitamin B-12 blood concentrations with cognitive-test performance or Alzheimer’s disease, nor was B-vitamin dietary intake associated ith cognitive function. Higher plasma homocysteine concentrations were associated with poorer cognitive function. Although the majority of studies indicated that low blood folate concentrations predicted poorer cognitive function, data supporting this associationwere limited because of the heterogeneity in cognition-assess mentmethodology, and scarcity of good quality studies and standardized threshold levels for categorizing low B-vitamin status.;There is currently no evidence to suggest that vitamin B12 and folate are effective in the routine treatment of Alzheimer’s disease but trials are ongoing which will provide type 1a evidence (B);B12缺乏/HHcy;B12缺乏致病机制-高Hcy;目 录;维生素B12缺乏的诊治流程;药物治疗的几种观点;B12缺乏的药物治疗;用药注意事项;小 结;Vitamin B 1 2 ?！;