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目的探讨老年与青少年巨幼细胞性贫血的临床特点。方法选择102例巨幼细胞性贫血患者,分为老年组(n=73)和青少年组(n=29),分析两组患者贫血的原因和误诊情况,比较骨髓象,外周血象等检查资料,结果老年和青少年患者贫血原因中以营养摄入不足比率最高(老年20例,27.4%;青少年18例62.1%)。老年患者的骨髓象以活跃,明显活跃的比率较高,而青少年患者以季度活跃和明显的为主。老年组患者外周血的血红蛋白,白细胞,血小板水平均显著高于青少年组(p<0.05)。结果老年患者中误诊24例,误诊率为33.3%,显著高于青少年组的6.9%。两组治疗后血常规均回复正常,但老年组患者的血红蛋白水平恢复正常的时间(30.5±3),显著长于青少年组(19.7±2.1)。结论老年巨幼细胞性贫血患者因临床症状非特异而误诊,其主要病因在于维生素B12、叶酸的摄入不足,表现为全血细胞水平下降者的比率更高,临床上需要积极掌握老年巨幼细胞性贫血临床特点,对降低误诊率,提高治愈率具有重要意义。
Objective To investigate the clinical features of megaloblastic anemia in the elderly and adolescents. Methods A total of 102 patients with megaloblastic anemia were divided into the elderly group (n = 73) and the adolescent group (n = 29). The causes of anemia and the misdiagnosis status were analyzed. The bone marrow and peripheral blood were compared. Results Among the causes of anemia in elderly and adolescent patients, the highest nutritional deficit was found (20 elderly patients, 27.4%; adolescents, 62.1%). Older patients have a significantly higher rate of active, significantly more active bone marrow, while adolescents are predominantly active and predominant on a quarterly basis. The levels of hemoglobin, white blood cells and platelets in the peripheral blood of the elderly group were significantly higher than those of the adolescent group (p <0.05). Results 24 cases were misdiagnosed in elderly patients, the rate of misdiagnosis was 33.3%, which was significantly higher than that of adolescent group (6.9%). The blood routine returned to normal after treatment in both groups, but the hemoglobin level returned to normal in the elderly group (30.5 ± 3), significantly longer than that in the adolescent group (19.7 ± 2.1). Conclusions Missed diagnosis of senile megaloblastic anemia due to nonspecific clinical symptoms is mainly due to the ingestion of vitamin B12 and folic acid insufficiency. The percentage of those with decreased level of whole blood cells is higher. Clinically, it is necessary to master the elderly megaloblastic Clinical features of anemia, to reduce the rate of misdiagnosis and improve the cure rate is of great significance.