[Association between subacute combined degeneration, vitamin B12 deficiency and megaloblastic anemia].
OBJECTIVE
To investigate the association between subacute combined degeneration (SCD) and vitamin B(12) (VB(12)) deficiency and megaloblastic anemia (MA).


METHODS
The serum level of VB(12), severity of anemia and lesions in CNS were analysed in 36 cases diagnosed as SCD. In addition, MRI neuro-electrophysiologic examination and CSF myelin basic protein (MBP) concentration were monitored dynamically. The prognosis of SCD was evaluated in relation to the time of the initiation of therapy.


RESULTS
Average ferrohemoglobin level in patients was (77.1 +/- 11.2) g/L and the average blood serum level of VB(12) was (87.0 +/- 21.4) ng/L before treatment with an abnormality rate of 47.2%. However, there was no linear correlation between the severity of lesions in CNS and ferrohemoglobin level or level of serum VB(12) (correlation coefficient: r = -0.1917, 0.0926, P > 0.5; r = 0.207, 0.101, P > 0.5, respectively). The comprehensive abnormal rate of evoked potential was 100%, which might occur prior to the clinical symptoms of SCD. The abnormal rate of MRI was 71.4%, and some lesions could diminish or disappear after treatment. The MBP levels in CSF were (3.96 +/- 1.66) ng/L, and (2.25 +/- 1.66) ng/L before and 3 months after the treatment. No significant improvement of symptoms and signs were seen when the treatment was initiated 6 months after the diagnosis.


CONCLUSIONS
SCD is associated with VB(12) deficiency and often accompanied by MA, but there is no linear correlation. Lesions of SCD in spinal cord or brain can be demonstrated in MRI. Evoked potential is critical for early diagnose and identification of silent cases of SCD. The level of MBP in CSF can reflect the severity of the lesion and prosthetic state of myelin sheath. Early diagnosis and treatment play an important role in decreasing the degree of the permanent dysfunction of CNS in SCD.
Zhou
Jin
J
Department of Hematology, First Hospital of Harbin Medical University, Harbin 150001, China. Jinzhou@lycos.com
Meng
Ran
R
Li
Guo-zhong
GZ
Liu
Zhi-ping
ZP
Wang
De-sheng
DS
Yang
Bao-feng
BF
D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000749:Anemia, Megaloblastic / Q000150:complications*; D005260:Female; D006801:Humans; D008279:Magnetic Resonance Imaging; D008297:Male; D008875:Middle Aged; D004676:Myelin Basic Protein / Q000134:cerebrospinal fluid; D019636:Neurodegenerative Diseases / Q000175:diagnosis / Q000209:etiology* / Q000503:physiopathology; D014806:Vitamin B 12 Deficiency / Q000150:complications*
D004676:Myelin Basic Protein