背景:关于不同维生素B12给药途径对维生素B12缺乏性大细胞-巨幼细胞性贫血的疗效的儿童文献有限。
目的:比较肠胃外和口服维生素B12治疗儿童巨幼细胞性贫血。
方法:单中心,开放标签随机对照试验。
方法:80例2个月至18岁的儿童,有营养性大细胞性贫血的临床和实验室特征。
方法:所有儿童接受1000µg维生素B12的初始单次肠胃外剂量,然后随机分为肠胃外或口服维生素B12用于后续剂量。A组给予1000µg肌内(IM)维生素B12(年龄<10岁的人每隔一天服用3剂,年龄>10岁的五剂),随后两个剂量每月服用1000微克IM。B组每天口服维生素B121500µg(<2岁时500µg),持续三个月。叶酸和铁的营养,和相关的饮食建议以相似的方式给予两组。
结果:比较治疗后3个月血清维生素B12水平和总血红蛋白的改善情况。
结果:A组血清维生素B12水平的中位数(IQR)增加明显高于[600(389,775)vs399(313,606)pg/mL;P=0.016]。A组血红蛋白的中位数(IQR)升高也更多[2.7(0.4,4.6)vs0.5(-0.1,1.2)g/dL;P=0.001]。
结论:与口服维生素B12相比,胃肠外营养性大细胞性贫血患儿血清维生素B12水平和血红蛋白的升高更好。
There is limited literature in children on efficacy of different routes of vitamin B12 administration for vitamin B12 deficiency macrocytic-megaloblastic anemia.
To compare parenteral with oral vitamin B12 therapy in children with macrocytic-megaloblastic anemia.
Single-center, open-label randomized controlled
trial.
80 children aged 2 month-18 year with clinical and laboratory features of nutritional macrocytic anemia.
All children received an initial single parenteral dose of 1000 µg vitamin B12 followed by randomization to either parenteral or oral vitamin B12 for subsequent doses. Group A was given 1000 µg intramuscular (IM) vitamin B12 (3 doses on alternate days for those aged <10 year, five doses for age >10 year), followed by monthly 1000 µg IM for the subsequent two doses. Group B was given daily oral vitamin B12 1500 µg (500 µg in <2 years age) for three months. Folic acid and iron supple-mentation, and relevant dietary advice were given to both groups in a similar fashion.
Improvement in serum vitamin B12 levels and total hemoglobin was compared three months post-treatment.
The median(IQR) increase in serum vitamin B12 level was significantly higher in group A [600 (389,775) vs 399 (313, 606) pg/mL; P= 0.016]. The median (IQR) rise of hemoglobin was also more in group A [2.7 (0.4,4.6) vs 0.5 (-0.1,1.2) g/dL; P=0.001].
Increase in serum vitamin B12 levels and hemoglobin was better in children with nutritional macrocytic anemia receiving parenteral as compared to oral vitamin B12.