PDF(Pubmed)
Abstract：
Whether the long-term treatment of patients with proton pump inhibitors (PPIs) with different diseases [GERD, Zollinger-Ellison syndrome (ZES), etc.] can result in vitamin B12 (VB12) deficiency is controversial. In this study, in 175 patients undergoing long-term ZES treatment with anti-acid therapies, drug-induced control acid secretory rates were correlated with the presence/absence of VB12 deficiency, determined by assessing serum VB12 levels, measurements of VB12 body stores (blood methylmalonic acid (MMA) and total homocysteine[tHYC]), and other features of ZES. After a mean of 10.2 yrs. of any acid treatment (5.6 yrs. with PPIs), 21% had VB12 deficiency with significantly lower serum and body VB12 levels (p < 0.0001). The presence of VB12 deficiency did not correlate with any feature of ZES but was associated with a 12-fold lower acid control rate, a 2-fold higher acid control pH (6.4 vs. 3.7), and acid control secretory rates below those required for the activation of pepsin (pH > 3.5). Over a 5-yr period, the patients with VB12 deficiency had a higher rate of achlorhydria (73% vs. 24%) and a lower rate of normal acid secretion (0% vs. 49%). In conclusion, in ZES patients, chronic long-term PPI treatment results in marked acid hyposecretion, resulting in decreased serum VB12 levels and decreased VB12-body stores, which can result in VB12 deficiency.
摘要：
是否长期使用质子泵抑制剂（PPI）治疗不同疾病的患者[GERD，Zollinger-Ellison综合征（ZES），等。]可导致维生素B12(VB12)缺乏是有争议的。在这项研究中,在175例接受抗酸治疗的长期ZES治疗的患者中，药物诱导的对照酸分泌率与VB12缺乏的存在/不存在相关，通过评估血清VB12水平来确定，VB12身体储存的测量（血液甲基丙二酸（MMA）和总同型半胱氨酸[tHYC]），以及ZES的其他功能。平均10.2年后。任何酸处理（5.6年。使用PPI)，21%的人患有VB12缺乏症，血清和身体VB12水平明显降低（p<0.0001）。VB12缺乏的存在与ZES的任何特征无关，但与低12倍的酸控制率有关。酸控制pH值高2倍（6.4vs.3.7),和酸控制分泌率低于胃蛋白酶活化所需的分泌率(pH>3.5)。在5年的时间里，VB12缺乏症患者的胃酸血症发生率较高(73%vs.24%）和较低的正常酸分泌率（0%vs.49%)。总之,在ZES患者中，慢性长期PPI治疗会导致明显的酸分泌减少，导致血清VB12水平下降和VB12身体储存减少，这可能导致VB12缺乏。
