双下肢乏力伴叶酸缺乏患者临床特征的研究

doi:10.3969/j.issn.1000-8535.2023.08.004

摘要/Abstract

摘要： 目的总结以双下肢乏力为主要表现的、合并低叶酸血症的患者的临床特征。方法选择自2017年1月—2020年12月在我院神经内科住院的患者,分为3组：双下肢乏力伴叶酸缺乏组,共23例;叶酸缺乏合并脑血管病组,共129例;叶酸缺乏的健康体检者,为来我院行健康体检、无意中发现叶酸水平降低者,共42例,比较3组患者特征。结果双下肢乏力伴叶酸缺乏组患者的发病年龄在19~88岁之间,平均（63.82±20.24）岁,男女比为2.3∶1。起病时间（13.34±17.88）d。与叶酸缺乏合并脑血管病组以及与叶酸缺乏的健康体检者相比,双下肢乏力伴叶酸缺乏组患者脑叶缺血灶数量较少,差异有统计学意义,P分别=0.001和0.008;与叶酸缺乏的健康体检者相比,双下肢乏力伴叶酸缺乏组患者放射冠和侧脑室缺血灶数量无变化,差异无统计学意义,P>0.05;与叶酸缺乏合并脑血管病组以及与叶酸缺乏的健康体检者相比,双下肢乏力伴叶酸缺乏组患者整体脑组织缺血灶总数较少,差异有统计学意义,P分别<0.01和0.05。结论临床上遇到双下肢乏力患者,尤其是发病年龄在63岁左右,男性,起病时间在13 d左右,颅内整体缺血灶、尤其脑叶缺血灶较少的患者,需要警惕低叶酸血症所致双下肢乏力的可能。

关键词: 叶酸, 脑缺血, 乏力

Abstract: Objective To summarize the clinical characteristics of patients with lower extremity weakness as the main manifestation and hypofolicemia．Methods Patients admitted in our neurology inpatient center from January 2017 to December 2020 were selected and divided into 3 groups．Group A consisted of 23 cases of bilateral lower extremity weakness combined with folic acid deficiency．Group B consisted of 129 cases of folic acid deficiency combined with cerebrovascular disease．Group C consisted of 42 healthy people with folic acid deficiency who came to our hospital for health check-up and found that the level of folic acid was decreased accidentally．The clinical characteristics of the three groups of patients were compared．Results The age of onset in group A was between 19 and 88 years old,with an average of（63.82±20.24）years old,and the male to female ratio was 2.3∶1．The onset time was（13.34±17.88）days．Compared with the group B and group C,the number of cerebral lobe ischemic area in group A was lesser,and the difference was statistically significant,P=0.001 and 0.008,respectively．Compared with group C,the number of corona radiata and lateral ventricle ischemic lesions in group A did not change,and the difference was not statistically significant,P>0.05．Compared with group B and group C,the total number of ischemic lesions in the overall brain tissue of group A was lesser,and the difference was statistically significant,P<0.01 and P=0.05 respectively．Conclusions When we encounter patients with bilateral lower extremity weakness in clinical practice,especially the average age of onset is around 63 years old,male,the onset time is about 13 days,and the overall intracranial ischemic lesions,especially the lobar ischemic lesions are less,we need to think of the possibility of bilateral lower extremity weakness caused by hypofolate．

Key words: folic acid, cerebral ischemia, weakness

余爱勇, 薛冬梅, 杨柳, 赵迎春, 周克贵. 双下肢乏力伴叶酸缺乏患者临床特征的研究[J]. 广州医药, 2023, 54(8): 22-28.

YU Aiyong, XUE Dongmei, YANG Liu, ZHAO Yingchun, ZHOU Kegui. Study on the clinical characteristics of patients with lower extremity weakness and folic acid deficiency[J]. Guangzhou Medical Journal, 2023, 54(8): 22-28.

参考文献

[1] DEHGHANI DOLATABADI H R,REISI P,ALAEI H,et al.Folic acid and coenzyme Q10 ameliorate cognitive dysfunction in the rats with intracerebroventricular injection of streptozotocin[J].Iran J Basic Med Sci,2012,15(2):719-724.
[2] 余爱勇,赵迎春,陈晟,等.行走不稳伴叶酸缺乏患者病变特征研究[J].中风与神经疾病杂志,2020,37(11):1021-1026.
[3] 余爱勇,赵迎春,陈晟,等.血清叶酸水平降低对血糖和脑梗死TOAST分型影响的研究[J].中风与神经疾病杂志,2020,37(8):694-698.
[4] HWANG S Y,KANG Y J,SUNG B,et al.Folic acid promotes the myogenic differentiation of C2C12 murine myoblasts through the Akt signaling pathway[J].Int J Mol Med,2015,36(4):1073-1080.
[5] HWANG S Y,KANG Y J,SUNG B,et al.Folic acid is necessary for proliferation and differentiation of C2C12 myoblasts[J].J Cell Physiol,2018,233(2):736-747.
[6] PENNISI M,MALAGUARNERA G,DI BARTOLO G,et al.Decrease in serum vitamin d level of older patients with fatigue[J].Nutrients,2019,11(10):2531-2541.
[7] KASLOW J E,RUCKER L,ONISHI R.Liver extract-folic acid-cyanocobalamin vs placebo for chronic fatiguesyndrome[J].Arch Intern Med,1989,149(11):2501-2503.
[8] FUKUDA S,KOYAMA H,KONDO K,et al.Effects of nutritional supplementation on fatigue,and autonomic and immune dysfunction in patients with end-stage renal disease:a randomized,double-blind,placebo-controlled,multicenter trial[J].PLoS One,2015,10(3):e0119578.
[9] 中华医学会神经病学分会,中华医学会神经病学分会脑血管病学组.中国急性缺血性脑卒中诊治指南2014[J].中华神经科杂志,2015,48(4):246-257.
[10] LOVETT R W.The treatment of infantile paralysis[M].Philadelphia:Blakiston’s Son,1917:1-2.
[11] LI W,MA Y,LI Z,et al.Folic acid decreases astrocyte apoptosis by preventing oxidative stress-induced telomere attrition[J].Int J Mol Sci,2019,21(1):62.
[12] MAN C,LIU Y,ZHIPING D,et al.Folic acid deficiency enhanced microglial immune response via the notch1/nuclear factor kappa B p65 pathway in hippocampus following rat brain I/R injury and BV2 cells[J].J Cell Mol Med,2019,23(7):4795-4807.
[13] JUNG J Y,LEE H S,KANG D G,et al.1H-NMR-based metabolomics study of cerebral infarction[J].Stroke,2011,42(5),1282-1288.
[14] MAHAJAN S K,AUNDHAKAR S C.A study of the prevalence of serum vitamin B12 and folic acid deficiency in western maharashtra[J].J Family Med Prim Care,2015,4(1):64-68.
[15] HWANG S Y,SUNG B,KIM N D.Roles of folate in skeletal muscle cell development and functions[J].Arch Pharm Res,2019,42(4):319-325.
[16] LI Y,ZHANG X,SUN Y,et al.Folate deficiency during early-mid pregnancy affects the skeletal muscle transcriptome of piglets from a reciprocal cross[J].PLoS ONE,2013,8(12):e82616.
[17] OSTER M,TRAKOOLJUL N,REYER H,et al.Sex-specific muscular maturation responses following prenatal exposure to methylation-related micronutrients in pigs[J].Nutrients,2017,9(1):74.
[18] WEE A K.Serum folate predicts muscle strength:a pilot cross-sectional study of the association between serum vitamin levels and muscle strength and gait measures in patients>65 years old with diabetes mellitus in a primary care setting[J].Nutr J,2016,15(1):89.
[19] van DIJK M,DIJK F J,HARTOQ A,et al.Reduced dietary intake of micronutrients with antioxidant properties negatively impacts muscle health in aged mice[J].J Cachexia Sarcopenia Muscle,2018,9(1):146-159.
[20] VEERANKI S,WINCHESTER L J,TYAGI S C.Hyperhomocysteinemia associated skeletal muscle weakness involves mitochondrial dysfunction and epigenetic modifications[J].Biochim Biophys Acta,2015,1852(5):732-741.
[21] QIN L,WANG W,YOU S,at al.In vitro antioxidant activity and in vivo antifatigue effect of layered double hydroxide nanoparticles as delivery vehicles for folic acid[J].Int J Nanomedicine,2014,4(9):5701-5710.
[22] BHARGAVA S,TYAGI S C.Nutriepigenetic regulation by folate-homocysteine-methionine axis:a review[J].Mol Cell Biochem,2014,387(1-2):55-61.
[23] STAM F,SMULDERS Y M,VAN GULDENER C,et al.Folic acid treatment increases homocysteine remethylation and methionine transmethylation in healthy subjects[J].Clin Sci(Lond),2005,108(5):449-456.
[24] SWART K M,ENNEMAN A W,van WIJNGAARDENJ P,et al.Homocysteine and the methylenetetrahydrofolate reductase 677C-->T polymorphism in relation to muscle mass and strength,physical performance and postural sway[J].Eur J Clin Nutr,2013,67(7):743-748.