ビタミンB12欠乏症

ビタミンB12欠乏症
シアノコバラミン
概要
診療科 神経学
分類および外部参照情報
ICD-10 E53.8
ICD-9-CM 266.2
DiseasesDB 13905
MedlinePlus 000574
Patient UK ビタミンB12欠乏症

ビタミンB12 欠乏症(ビタミンびーじゅうにけつぼうしょう)、または低コバラミン血症(ていコバラミンけっしょう)は、血中の シアノコバラミン(ビタミンB12)濃度が低いことをいう[1]

解説

ビタミンB12血液レベルが、200pg/mL(145pmo/L)を下回る場合にビタミンB12欠乏症を示す。欠乏の主要原因は3つに分類される[2]

  1. 吸収障害(吸収力の低下)
  2. 摂取の減少(不適切な食事)
  3. 利用障害

成人の診断は、ビタミンB12 血液レベルの正常化下限(200〜350pg/mL [145〜260pmol/L])以下。またメチルマロン酸レベルが高い人(値>0.4micromol/L)も欠乏症と診断される。しかし、メチルマロン酸値の上昇は、マロン酸値の上昇を伴う場合、見落とされがちな[9]代謝異常、マロン酸およびメチルマロン酸尿合併症(CMAMMA)を示すこともある[10]

欠乏症と診断された場合は、サプリメントにより経口投与(もしくは注射)で簡単に治療できる[11]唾液・胃液により吸収が進められる。菜食主義の妊婦には欠乏予防のためにサプリメント補給を推奨される[12]。健康な人の過剰ビタミンB12 摂取による害はない[12]。場合によっては根本的な原因の改善で治ることがある[13]。根本的な原因の改善で治らないその他の場合は継続的なサプリメントの摂取を必要とする[14]。60歳下の発症は約6%、60歳以上の発症は約20%である。アフリカアジアでは発症率が80%を上まわる地域もある[4]

症状

欠乏が進行すると貧血症状を起こすことがあるが、欠乏が軽度の場合は現れない。脾腫および肝腫大が生じる。希に舌炎。

消化管症状は食欲不振、便秘、および限局性に乏しい腹痛

神経症状は、思考力の低下やうつ病、興奮、情緒不安定(イライラ)などの性格の変化がある。 痺れ反射の変化、味覚症害心機能低下生殖率低下などがある[4]。子供にみられる症状は成長障害発達障害運動障害などがある[12]。早期に治療されなかった場合、生涯的な症状障害になりえる[15]

小児の場合、脳発達障害や成長障害[16]

治療

ビタミンB12製剤の皮下注射、経口投与。

出典

  1. ^ Herrmann, Wolfgang (2011). Vitamins in the prevention of human diseases. Berlin: Walter de Gruyter. p. 245. ISBN 9783110214482. https://books.google.it/books?id=b9ahvNjPFO8C&pg=PA245 
  2. ^ ビタミンB12 メルクマニュアル
  3. ^ 胃内壁から分泌される。小腸でビタミンB12へ結合する。
  4. ^ a b c d Hunt, A; Harrington, D; Robinson, S (4 September 2014). “Vitamin B12 deficiency.”. BMJ (Clinical research ed.) 349: g5226. doi:10.1136/bmj.g5226. PMID 25189324. 
  5. ^ ビタミンB12を食物から遊離させ、唾液・胃液中のRタンパク質へ結合させる。
  6. ^ 小腸のアルカリ性環境下で、Rタンパク質と結合していたビタミンB12が膵酵素により遊離され、内因子との結合が行われる。その複合体が回腸で吸収される。
  7. ^ 芥川香奈, 細野茂春, 長野伸彦 ほか、「胃全摘術後の母体から出生し完全母乳栄養によりビタミンB12欠乏性貧血を呈した1例」『日本産婦人科・新生児血液学会誌』 21(1), "S-55"-"S-56", 2011-06-01, NAID 10029378127
  8. ^ 馬場美子ほか、「臨床研究・症例報告 精神発達遅延を伴い,食物アレルギーに対する動物性食品回避によりビタミンB12欠乏性大球性貧血を来した12歳男児」『小児科臨床』 65(1), 67-74, 2012-01, NAID 40019087688
  9. ^ NIH Intramural Sequencing Center Group; Sloan, Jennifer L; Johnston, Jennifer J; Manoli, Irini; Chandler, Randy J; Krause, Caitlin; Carrillo-Carrasco, Nuria; Chandrasekaran, Suma D et al. (2011-09). “Exome sequencing identifies ACSF3 as a cause of combined malonic and methylmalonic aciduria” (英語). Nature Genetics 43 (9): 883–886. doi:10.1038/ng.908. ISSN 1061-4036. PMC 3163731. PMID 21841779. http://www.nature.com/articles/ng.908. 
  10. ^ de Sain-van der VeldenMonique G. M.; van der HamMaria; JansJudith J.; VisserGepke; PrinsenHubertus C. M. T.; Verhoeven-DuifNanda M.; van GassenKoen L. I.; van HasseltPeter M. 著、MoravaEva; BaumgartnerMatthias 編『A New Approach for Fast Metabolic Diagnostics in CMAMMA』 30巻、Springer Berlin Heidelberg、2016年、15–22頁。doi:10.1007/8904_2016_531ISBN 978-3-662-53680-3PMC 5110436PMID 26915364http://link.springer.com/10.1007/8904_2016_531 
  11. ^ Vidal-Alaball, J; Butler, CC; Cannings-John, R; Goringe, A; Hood, K; McCaddon, A; McDowell, I; Papaioannou, A (20 July 2005). “Oral vitamin B12 versus intramuscular vitamin B12 for vitamin B12 deficiency.”. The Cochrane database of systematic reviews (3): CD004655. doi:10.1002/14651858.CD004655.pub2. PMID 16034940. 
  12. ^ a b c Dietary Supplement Fact Sheet: Vitamin B12 — Health Professional Fact Sheet”. National Institutes of Health: Office of Dietary Supplements (2016年2月11日). 2016年7月15日閲覧。
  13. ^ Wardlaw, Graeme J. Hankey, Joanna M. (2008). Clinical neurology. London: Manson. p. 466. ISBN 9781840765182. https://books.google.it/books?id=Q8q7E6EJr7IC&pg=PA466 
  14. ^ Schwartz, William (2012). The 5-minute pediatric consult (6th ed.). Philadelphia: Wolters Kluwer Health/Lippincott Williams & Wilkins. p. 535. ISBN 9781451116564. https://books.google.it/books?id=v7pbSFfMHCoC&pg=PA535 
  15. ^ Lachner, C; Steinle, NI; Regenold, WT (2012). “The neuropsychiatry of vitamin B12 deficiency in elderly patients.”. The Journal of neuropsychiatry and clinical neurosciences 24 (1): 5–15. doi:10.1176/appi.neuropsych.11020052. PMID 22450609. 
  16. ^ 鎌田彩子, 大日方薫, 鈴木光幸 ほか, 「吸収障害の関与が考えられた乳児期発症のビタミンB12 欠乏性巨赤芽球性貧血の女児例」『順天堂医学』 58巻 3号 2012年 p.256-260, doi:10.14789/pjmj.58.256

参考文献

さらに読む
  • Pacholok, Sally M.; Stuart, Jeffrey J. (2011). Could It Be B12?: An Epidemic of Misdiagnoses. Fresno, CA: Linden Publishing. ISBN 978-1-61035-065-5 
  • Hooper, M. (2012). Pernicious Anaemia: The Forgotten Disease - the causes and consequences of Vitamin B12 Deficiency. London: Hammersmith Press. ISBN 978-1-78161-004-6 

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