{"id":221,"date":"2019-12-19T16:14:45","date_gmt":"2019-12-19T16:14:45","guid":{"rendered":""},"modified":"2019-12-19T16:15:49","modified_gmt":"2019-12-19T16:15:49","slug":"retos-nesciuju-anemijos-folio-rugsties-ir-vitamino-b12-stokos-sukelta-anemija","status":"publish","type":"post","link":"https:\/\/www.pasveik.lt\/lt\/rekomenduojamos-naujienos\/retos-nesciuju-anemijos-folio-rugsties-ir-vitamino-b12-stokos-sukelta-anemija\/221\/","title":{"rendered":"Retos n\u0117\u0161\u010di\u0173j\u0173 anemijos: folio r\u016bg\u0161ties ir vitamino B12 stokos sukelta anemija"},"content":{"rendered":"

Ma\u017eakraujyst\u0117, arba anemija, yra b\u016bkl\u0117, kai organizme suma\u017e\u0117ja hemoglobino ir\u00a0\/\u00a0ar eritrocit\u0173 koncentracija. Eritrocitai yra atsakingi u\u017e deguonies perne\u0161im\u0105 \u017emogaus organizme. Suma\u017e\u0117jus deguonies perna\u0161ai \u012f audinius, kyla j\u0173 hipoksija. Da\u017eniausia ma\u017eakraujyst\u0117s prie\u017eastis\u00a0\u2013 gele\u017eies stoka (96\u00a0proc. atvej\u0173). Folio r\u016bg\u0161ties ir vitamino\u00a0B12<\/sub> stokos anemijos priskiriamos megaloblastini\u0173 anemij\u0173 grupei, kurios pasirei\u0161kia eritrocit\u0173 makrocitoze. \u0160ios r\u016b\u0161ies anemijos da\u017enesn\u0117s besivystan\u010diose \u0161alyse, kuriose maisto kokyb\u0117 yra prastesn\u0117. Lietuvoje maistas yra kokybi\u0161kesnis, \u012fvairesnis, nema\u017eai produkt\u0173 yra papildyti \u012fvairiais vitaminais, folio r\u016bg\u0161timi, vitaminu\u00a0B12<\/sub>, tod\u0117l ma\u017eakraujyst\u0117s atvejai d\u0117l \u0161i\u0173 med\u017eiag\u0173 stokos m\u016bs\u0173 kra\u0161te yra reti. Did\u017eiausi\u0105 rizik\u0105 susirgti turi vaikai iki 5 met\u0173, vaisingo am\u017eiaus ir besilaukian\u010dios moterys\u00a0[1].<\/p>\n

N\u0117\u0161\u010di\u0173j\u0173 ma\u017eakraujyst\u0117\u00a0\u2013 tai liga, i\u0161sivystanti n\u0117\u0161tumo laikotarpiu. Gele\u017eies stoka yra da\u017eniausia n\u0117\u0161\u010di\u0173j\u0173 anemijos prie\u017eastis. Moksliniais tyrimais patvirtinta, kad profilaktin\u0117 folio r\u016bg\u0161ties doz\u0117 suma\u017eina nervinio vamzdelio defekt\u0173 i\u0161sivystymo rizik\u0105\u00a0[2]. Profilakti\u0161kai skiriant folio r\u016bg\u0161t\u012f, jos stokos n\u0117\u0161\u010di\u0173j\u0173 ma\u017eakraujyst\u0117 pasitaiko retai. Izoliuota vitamino\u00a0B12<\/sub> stokos ma\u017eakraujyst\u0117 n\u0117\u0161\u010diosioms pasitaiko labai retai\u00a0[3].<\/p>\n

\u0160iame straipsnyje nenagrin\u0117sime gele\u017eies stokos sukeltos ma\u017eakraujyst\u0117s, o aptarsime retas, folio r\u016bg\u0161ties ir vitamino\u00a0B12<\/sub> stokos n\u0117\u0161\u010di\u0173j\u0173 anemijas, j\u0173 prie\u017eastis, simptomus, gydym\u0105 ir i\u0161eitis motinai bei vaisiui.<\/p>\n

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Folio r\u016bg\u0161tis: istorin\u0117 ap\u017evalga<\/b><\/p>\n

Mokslinink\u0117 L.\u00a0Willis 1928 metais nagrin\u0117jo n\u0117\u0161\u010di\u0173 moter\u0173 makrocitin\u0117s anemijos prie\u017eastis Bomb\u0117jaus tekstil\u0117s fabrike. Mokslinink\u0117 susiejo, kad \u0161ios r\u016b\u0161ies anemija da\u017eniau i\u0161sivysto moterims, kurios patiria maisto nepritekli\u0173. Atlikusi bandymus su \u017eiurk\u0117mis, ji pasteb\u0117jo, kad gyv\u016bnai, kuriems \u012f pa\u0161ar\u0105 papildomai dedama mieli\u0173, ma\u017eakraujyste neserga. Mieli\u0173 ekstraktu mokslinink\u0117 gyd\u0117 besilaukian\u010dias Bomb\u0117jaus moteris. 1932 metais J.\u00a0Vaughan pasteb\u0117jo, kad pacientams, sergantiems celiakija ar idiopatine steator\u0117ja bei ken\u010diantiems nuo megaloblastin\u0117s hiperchromin\u0117s anemijos, mieli\u0173 ekstraktas teigiamai veikia ligos simptomus.<\/p>\n

\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0 Folio r\u016bg\u0161ties pavadinimas kilo i\u0161 lotyni\u0161ko \u017eod\u017eio folium<\/i>, rei\u0161kian\u010dio lapas<\/i>. Pirm\u0105 kart\u0105 folio r\u016bg\u0161tis i\u0161skirta 1941 metais i\u0161 \u0161pinat\u0173 lap\u0173. V\u0117liau pasteb\u0117ta, kad folio r\u016bg\u0161tis gydo megaloblastines anemijas\u00a0\u2013 labiausiai tas, kurios buvo atsparios kepen\u0173 preparat\u0173 gydymui\u00a0[4].<\/p>\n

Folat\u0173 stoka n\u0117\u0161\u010diosioms, pasirei\u0161kianti megaloblastine anemija, yra reta, ta\u010diau folio r\u016bg\u0161tis yra labai svarbi besivystan\u010diam vaisiui. Pirm\u0105 kart\u0105 ry\u0161ys tarp folat\u0173 stokos ir nervinio vamzdelio defekt\u0173 nustatytas 1965 metais\u00a0[5]. Brit\u0173 medicinini\u0173 tyrim\u0173 taryba atlikto atsitiktin\u0117s imties tyrim\u0105, kuriuo patvirtina, kad profilaktinis 400\u00a0\u03bcg folio r\u016bg\u0161ties vartojimas n\u0117\u0161tumo metu 70\u00a0proc. suma\u017eina vaisiaus nervinio vamzdelio defekt\u0173 da\u017en\u012f [6]. Vengr\u0173 atliktame atsitiktin\u0117s imties tyrime pabr\u0117\u017eiama, kad 800\u00a0\u03bcg folio r\u016bg\u0161ties vartojimas n\u0117\u0161tumo metu 92\u00a0proc. suma\u017eina nervinio vamzdelio defekt\u0173 i\u0161sivystymo tikimyb\u0119 [7].<\/p>\n

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Folio r\u016bg\u0161ties funkcijos<\/b> apykaita<\/b><\/b><\/p>\n

Terminas folatai<\/i> vartojamas didelei grupei jungini\u0173 apib\u016bdinti. \u0160i\u0105 grup\u0119 sudaro nat\u016bral\u016bs folatai ir folio r\u016bg\u0161tis, kuri\u0173 biocheminis aktyvumas yra pana\u0161us. Tr\u016bkstant folio r\u016bg\u0161ties, sutrinka DNR sintez\u0117\u00a0\u2013 vietoj normali\u0173 eritrocit\u0173 gaminami megaloblastai, kurie neatlieka normali\u0173 eritrocit\u0173 funkcijos.<\/p>\n

Folio r\u016bg\u0161ties daugiausiai esama \u017ealiuose lapuose, \u017eiediniuose kop\u016bstuose, aguro\u010diuose, moli\u016bguose. Folio r\u016bg\u0161ties randama ir gyvulin\u0117s kilm\u0117s produktuose\u00a0\u2013 kepenyse, inkstuose, kiau\u0161iniuose, \u017euvyse, miel\u0117se ir kituose grybuose. Rekomenduojamas folio r\u016bg\u0161ties kiekis suaugusiesiems yra 200\u00a0\u03bcg. N\u0117\u0161tumo metu, kai \u0161ios med\u017eiagos poreikis yra didesnis,\u00a0rekomenduojam vartoti ma\u017eiausiai 400\u00a0\u03bcg\/p. Folio r\u016bg\u0161tis absorbuojama plonojoje \u017earnoje ir did\u017eiausia jos koncentracija nustatoma kepenyse, o jos metabolitai i\u0161 organizmo pa\u0161alinami su \u0161lapimu. Normali folio r\u016bg\u0161ties koncentracija kraujo serume ir eritrocituose pateikiama 1\u00a0lentel\u0117je<\/i>.<\/p>\n

1 lentel\u0117. Normali folio r\u016bg\u0161ties koncentracija kraujo plazmoje ir eritrocituose\u00a0[<\/b>8]<\/b><\/b><\/p>\n\n\n\n\n\n\n
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Kraujo plazmoje<\/b><\/p>\n<\/td>\n

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Eritrocituose<\/b><\/p>\n<\/td>\n<\/tr>\n

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Suaugusiesiems\u00a0\u2013 2 \u201320\u00a0ng\/ml<\/p>\n<\/td>\n

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Suaugusiems\u00a0\u2013 140\u2013628\u00a0ng\/ml<\/p>\n<\/td>\n<\/tr>\n

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Vaikams\u00a0\u2013 5\u201321\u00a0ng\/ml<\/p>\n<\/td>\n

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Vaikams\u00a0\u2013 >160\u00a0ng\/ml<\/p>\n<\/td>\n<\/tr>\n

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Naujagimiams\u00a0\u2013 14\u201351\u00a0ng\/ml<\/p>\n<\/td>\n

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Folio r\u016bg\u0161ties stokos simptomai ir diagnostika<\/b><\/p>\n

Da\u017eniausiai folio r\u016bg\u0161ties stokos ma\u017eakraujyst\u0117 i\u0161sivysto \u017emon\u0117ms, sergantiems \u017earnyno ligomis, l\u0117tin\u0117mis hemolizin\u0117mis anemijomis, vartojantiems alkoholio, folat\u0173 metabolizm\u0105 veikian\u010dius vaistus (trimetoprim\u0105, barbit\u016bratus, nitrofurantoin\u0105) ar su maistu negaunant pakankamo \u0161ios med\u017eiagos kiekio (badaujama, yra padid\u0117j\u0119s jos poreikis). N\u0117\u0161tumo metu folat\u0173 s\u0105naudos padid\u0117ja nuo 100\u2013150\u00a0\u03bcg\/p. iki 200\u2013250\u00a0\u03bcg\/p. B\u016btent d\u0117l \u0161ios prie\u017easties besilaukian\u010dios moterys priskiriamos rizikos grupei.<\/p>\n

Motinai folio r\u016bg\u0161ties stoka sukelia megaloblastin\u0119 anemij\u0105. Klinikiniai simptomai pasirei\u0161kia i\u0161 l\u0117to, da\u017eniausiai antroje n\u0117\u0161tumo pus\u0117je, tod\u0117l gali b\u016bti nepasteb\u0117ti. Anemijos sindromui b\u016bdinga: bendras silpnumas, padid\u0117j\u0119s jautrumas, galvos skausmai, \u0161irdies permu\u0161imai, oro tr\u016bkumas. Ry\u0161k\u0117jant ma\u017eakraujystei, gali i\u0161sivystyti kr\u016btin\u0117s angina ir \u0161irdies nepakankamumas\u00a0[9].<\/p>\n

Folio r\u016bg\u0161ties stoka yra susijusi su vaisiaus apsigimimais, ypa\u010d su nervinio vamzdelio defektais (1\u00a0pav<\/i>.). <\/b>Nervinis vamzdelis susiformuoja 4 embriogenez\u0117s savait\u0119. Da\u017eniausiai nustatomi \u0161ie pakitimai: \u012fskilasis stuburas, besmegenyst\u0117, meningocel\u0117, mielomeningocel\u0117. \u0160ios patologijos da\u017enis\u00a0\u2013 0,5\u201312 atvej\u0173 1\u00a0t\u016bkst. gyv\u0173 gimusi\u0173j\u0173. Kasmet pasaulyje gimsta 400\u00a0t\u016bkst. toki\u0173 vaik\u0173. Epidemiologiniai tyrimai, atlikti Amerikoje, Kanadoje, Australijoje ir Europoje, parod\u0117, kad \u012fgimt\u0173j\u0173 nervinio vamzdelio defekt\u0173 per pastaruosius 3 de\u0161imtme\u010dius gerokai suma\u017e\u0117jo. Tai ai\u0161kinama vis ger\u0117jan\u010dia prenataline diagnostika ir platesniu folio r\u016bg\u0161ties vartojimu.<\/p>\n

Lietuvos paveldim\u0173j\u0173 lig\u0173 ir \u012fgimt\u0173 raidos defekt\u0173 registro duomenimis, 1993\u20132005 metais nervinio vamzdelio patologijos da\u017enis Lietuvoje buvo 1,52 atvejo 1\u00a0t\u016bkst. gyv\u0173 gimusi\u0173j\u0173, 2007 metais\u00a0\u2013 0,5 atvejo 1\u00a0t\u016bkst. gimusi\u0173j\u0173 naujagimi\u0173.<\/p>\n

Naujausi tyrimai rodo, kad folio r\u016bg\u0161ties vartojimas iki pastojimo gali tur\u0117ti \u012ftak\u0105 prie\u0161laikiniam gimdymui. Didel\u0117s apimties prospektyvinis, kohortinis tyrimas rodo, kad prie\u0161laikinio gimdymo rizika tiesiogiai yra susijusi su folio r\u016bg\u0161ties vartojimo trukme. Ma\u017eiausia rizika pagimdyti pirma laiko buvo moterims, kurios folio r\u016bg\u0161t\u012f iki pastojimo vartojo ilgiau nei metus\u00a0[10].<\/p>\n

Folio r\u016bg\u0161ties stokos anemijai b\u016bdinga megaloblastin\u0117 eritrocit\u0173 transformacija. Hematologinis vaizdas\u00a0\u2013 makrocitin\u0117 anemija, ta\u010diau j\u0105 gali maskuoti gele\u017eies stoka, kuriai b\u016bdinga mikrocitoz\u0117. Laboratoriniai tyrimai rodo folat\u0173 stok\u0105, kuri\u0173 kiekis kraujo serume svyruoja priklausomai nuo paros maisto davinio ir gali pasikeisti suvalgius daug \u0161i\u0173 med\u017eiag\u0173 turin\u010dio maisto [11]. Folat\u0173 kiek\u012f organizme tiksliau atspindi j\u0173 kiekis eritrocituose. Folio r\u016bg\u0161ties stoka diagnozuojama, kai jos kiekis kraujo serume yra ma\u017eesnis nei 2\u00a0ng\/ml. Reik\u0117t\u0173 nepamir\u0161ti, kad n\u0117\u0161\u010diajai b\u016bdinga hiperplazmija, tod\u0117l folat\u0173 koncentracija suma\u017e\u0117ja. Jeigu n\u0117\u0161\u010dioji serga anoreksija, badauja ar yra \u012ftariama vitamino\u00a0B12<\/sub> stoka, gali prireikti papildom\u0173 tyrim\u0173\u00a0\u2013 folat\u0173 kiekio eritrocituose, homocisteino ir metilmalonin\u0117s r\u016bg\u0161ties nustatymo ar kaul\u0173 \u010diulp\u0173 punkcijos\u00a0[8].<\/p>\n

Profilaktika ir gydymas<\/b><\/p>\n

Pagal Lietuvoje ir pasaulyje galiojan\u010dius standartus, iki pastojimo rekomenduojama gerti 400\u2013800\u00a0\u03bcg folio r\u016bg\u0161ties 1\u20133 m\u0117nesius. Toki\u0105 pat doz\u0119 reikia vartoti iki 12 n\u0117\u0161tumo savait\u0117s. Jeigu moteris ar jos \u0161eimos nariai serga cukriniu diabetu, epilepsija, ar yra gimd\u017eiusi\u0173j\u0173 naujagimius, turin\u010dius sklaidos tr\u016bkum\u0173, rekomenduojama paros doz\u0117 yra 5\u00a0mg. Nevartojus folio r\u016bg\u0161ties iki pastojimo, j\u0105 reik\u0117t\u0173 prad\u0117ti gerti i\u0161 karto su\u017einojus apie n\u0117\u0161tum\u0105\u00a0[24]. Kanadoje ir Jungtin\u0117se Amerikos Valstijose rekomenduojama t\u0119sti folio r\u016bg\u0161ties vartojim\u0105 viso n\u0117\u0161tumo ir \u017eindymo laikotarp\u012f\u00a0[12].<\/p>\n

Folio r\u016bg\u0161ties perdozavimas gali sukelti nepageidaujam\u0173 rei\u0161kini\u0173. Folio r\u016bg\u0161ties vartojimas gali sl\u0117pti vitamino\u00a0B12<\/sub> stok\u0105, tod\u0117l \u0161i patologija, nors ir yra itin reta n\u0117\u0161tumo metu, gali likti nediagnozuota. Yra duomen\u0173, kad nesuskaidyta sintetin\u0117 folio r\u016bg\u0161tis yra susijusi su padid\u0117jusia rizika susirgti v\u0117\u017eiu ar depresija\u00a0[13].<\/p>\n

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Vitaminas B12<\/sub>: istorin\u0117 ap\u017evalga<\/b><\/p>\n

1850 metais brit\u0173 gydytojas T.\u00a0Addisonas pirm\u0105 kart\u0105 apra\u0161\u0117 piktybin\u0119 anemij\u0105, susijusi\u0105 su patologi\u0161kai pakitusia skrand\u017eio gleivine. Jis pasteb\u0117jo, kad pacientams b\u016bdinga makrocitin\u0117 anemija, lie\u017euvio u\u017edegimas ir neurologiniai simptomai. Tuo metu nebuvo jokio efektyvaus gydymo, tod\u0117l visi pacientai mirdavo.<\/p>\n

1923 metais gydytojas G.\u00a0R.\u00a0Minotas ir W.\u00a0P.\u00a0Murphy\u02bcus pasteb\u0117jo, kad geriausiai \u0161un\u0173 ma\u017eakraujyst\u0119 gydo kepen\u0173 preparatai. Po keleto met\u0173 \u0161ie gydytojai \u017ealiomis kepenimis s\u0117kmingai i\u0161gyd\u0117 45 pacientus, sergan\u010dius piktybine ma\u017eakraujyste. Tuo metu nebuvo \u017einoma apie vitamin\u0105\u00a0B12<\/sub>. W.\u00a0Castle\u02bcis atrado vidin\u012f Kastlio faktori\u0173. 1948 metais pirm\u0105 kart\u0105 i\u0161 kepen\u0173 i\u0161skirtas i\u0161orinis faktorius ir pavadinamas vitaminu\u00a0B12<\/sub>. 1956 metais brit\u0173 chemik\u0117 D.\u00a0Hodgkin apra\u0161\u0117 vitamino\u00a0B12<\/sub> molekul\u0117s strukt\u016br\u0105. 1971 metais chemikas R.\u00a0Woodwardas susintetino vitamin\u0105\u00a0B12\u00a0<\/sub>[14].<\/p>\n

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Vitamino B12<\/sub> funkcijos ir apykaita<\/b><\/p>\n

Vitamino B12 <\/sub>(kobalamino) randama gyvulin\u0117s kilm\u0117s produktuose\u00a0\u2013 m\u0117soje, pieno produktuose ir kiau\u0161iniuose. Did\u017eiausia jo koncentracija yra moliuskuose ir kepenyse. Augaluose jo beveik n\u0117ra. Suaugusiems \u017emon\u0117ms vitamino\u00a0B12<\/sub> per par\u0105 reikia suvartoti 2,4\u00a0\u03bcg, besilaukian\u010dioms moterims\u00a0\u2013 2,6\u00a0\u03bcg, o maitinan\u010dioms k\u016bdik\u012f motinoms\u00a0\u2013 2,8\u00a0\u03bcg [15].<\/p>\n

Suaugusio \u017emogaus organizme susikaupia didel\u0117s vitamino B12<\/sub> atsargos (apie 3\u20135\u00a0mg), daugiausia kepenyse. Kai organizmas negauna vitamino B12<\/sub>, iki anemijos simptom\u0173 i\u0161sivystymo praeina 5\u201310 met\u0173. Naujagimiai, kuri\u0173 mamoms n\u0117\u0161tumo metu buvo diagnozuotas vitamino B12<\/sub> tr\u016bkumas, gali netur\u0117ti \u0161io vitamino atsarg\u0173\u00a0[16].<\/p>\n

Vitaminas B12<\/sub> yra susijung\u0119s su maisto baltymais. Skrandyje \u0161iems junginiams suskaidyti reikalinga r\u016bg\u0161tin\u0117 terp\u0117 ir pepsinas. Vitaminas B12 <\/sub>jungiasi su skrand\u017eio gleivin\u0117s i\u0161skiriamu vidiniu Kastlio faktoriumi. Absorbcija vyksta tik distalin\u0117je klubin\u0117s \u017earnos dalyje. Esant sutrikimui, bet kuriame metabolizmo etape vystosi vitamino B12<\/sub> anemija.<\/p>\n

Vitaminas B12 <\/sub>reikalingas DNR ir mielino sintezei. Tai yra svarbu vaisiaus nervinio vamzdelio vystymuisi. Manoma, kad \u0161ios med\u017eiagos stoka n\u0117\u0161tumo metu gali b\u016bti susijusi ir su padid\u0117jusia prie\u0161laikinio gimdymo ir ma\u017eo naujagimio svorio rizika [3].<\/p>\n

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Vitamino B12<\/sub> stokos sukeltos ma\u017eakraujyst\u0117s klasifikacija<\/b><\/p>\n

Vitamino B12<\/sub> stokos anemija skiriama \u012f:<\/p>\n

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  1. Alimentin\u0117s kilm\u0117s, kai gaunamas per ma\u017eas vitamino B12<\/sub> kiekis su maistu, pavyzd\u017eiui, esant grie\u017etam vegetarizmui, kai valgomas tik augalin\u0117s kilm\u0117s maistas.<\/li>\n
  2. Sutrikusi vitamino B12<\/sub> absorbcija:\n
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    • Gastrogenin\u0117, kai tr\u016bksta vidinio Kastlio faktoriaus:\n
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      • Addisono-Biermerio anemija (perniciozin\u0117).<\/li>\n
      • Agastrin\u0117 anemija (gastrektomija, subtotalin\u0117 rezekcija).<\/li>\n
      • Skrand\u017eio gleivin\u0117s destrukcija (korozinis gastritas).<\/li>\n<\/ul>\n<\/li>\n
      • Enterogenin\u0117:\n
          \n
        • Anenterija (terminalin\u0117s klubin\u0117s plonosios \u017earnos rezekcija).<\/li>\n
        • Biologin\u0117 konkurencija \u017earnyne d\u0117l vitamino B12<\/sub> (bakterijos, \u017euvinis kaspiniuotis).<\/li>\n
        • Plonojo \u017earnyno ligos.<\/li>\n
        • Selektyvioji malabsorbcija.<\/li>\n<\/ul>\n<\/li>\n<\/ul>\n<\/li>\n<\/ol>\n
            \n
          1. Padid\u0117jusios vitamino B12<\/sub> s\u0105naudos:\n
              \n
            • N\u0117\u0161tumas.<\/li>\n
            • Hipertiroz\u0117.<\/li>\n
            • Piktybiniai navikai.<\/li>\n<\/ul>\n<\/li>\n
            • Vaistai: proton\u0173 siurblio inhibitoriai, metforminas, histamino receptori\u0173 antagonistai, kt. [23].<\/li>\n<\/ol>\n

              \u00a0<\/p>\n

              Simptomai <\/b><\/p>\n

              Vitamino B12<\/sub> stoka paprastai vystosi l\u0117tai, tod\u0117l simptomai yra progresuojan\u010dio pob\u016bd\u017eio. Da\u017eniausiai pasirei\u0161kia anemijos sindromas, vir\u0161kinimo trakto ir neurologiniai simptomai. Klasikin\u0117 vitamino B12<\/sub> stokos triada yra bendras silpnumas, greitas nuovargis, lie\u017euvio u\u017edegimo simptomai ir parestezijos. Hunterio glositas pasirei\u0161kia apie 25\u00a0proc. atvej\u0173\u00a0(2\u00a0pav<\/i>.). Jis pasirei\u0161kia difuzine lie\u017euvio eritema, gleivin\u0117s atrofija, burnos skausmu\u00a0[17]. Vystosi u\u017epakalini\u0173 ir \u0161onini\u0173 nugaros smegen\u0173 \u0161ul\u0173 demielinizacija. Da\u017eniausiai pasirei\u0161kia simetrin\u0117s, ypa\u010d apatini\u0173 gal\u016bni\u0173, parestezijos ar tirpimas, eisenos sutrikimai\u00a0[15]. Gali i\u0161sivystyti ma\u017eieji cerebriniai simptomai\u00a0\u2013 depresija, susilpn\u0117jusi atmintis ir suma\u017e\u0117j\u0119s intelektas.<\/p>\n

              Diagnostika<\/b><\/p>\n

              Vitamino B12<\/sub>, kaip ir folio r\u016bg\u0161ties, anemijai b\u016bdinga megaloblastin\u0117 anemija ir ma\u017eas retikulocit\u0173 kiekis. Tiriamas serumo vitamino B12<\/sub> kiekis (2\u00a0lentel\u0117<\/i>).<\/p>\n

              \u00a0<\/p>\n\n\n\n\n\n\n
              \n

              Vitamino B12<\/sub> kiekis<\/b><\/p>\n<\/td>\n

              		\n

              Rezultato interpretacija<\/b><\/p>\n<\/td>\n<\/tr>\n

              \n

              >300 pg\/ml<\/p>\n<\/td>\n

              		\n

              Normalus kiekis<\/p>\n<\/td>\n<\/tr>\n

              \n

              200\u2013300 pg\/ml<\/p>\n<\/td>\n

              		\n

              Tarpinis rezultatas, galimas tr\u016bkumas. Naudingi papildomi testai<\/p>\n<\/td>\n<\/tr>\n

              \n

              <200 pg\/ml<\/p>\n<\/td>\n

              		\n

              Ma\u017eas kiekis<\/p>\n<\/td>\n<\/tr>\n<\/tbody>\n<\/table>\n

              \u00a0<\/p>\n

              \u00a0<\/p>\n

              \u00a0<\/p>\n

              2 lentel\u0117. Vitamino B12 <\/sub>koncentracija kraujo serume<\/b><\/p>\n

              \u00a0<\/p>\n\n\n\n\n\n\n
              \n

              Metilmalonin\u0117 r\u016bg\u0161tis<\/b><\/p>\n<\/td>\n

              		\n

              Homocisteinas<\/b><\/p>\n<\/td>\n

              		\n

              Vitamino B12<\/sub> tr\u016bkumas<\/b><\/p>\n<\/td>\n

              		\n

              Folio r\u016bg\u0161ties tr\u016bkumas<\/b><\/p>\n<\/td>\n<\/tr>\n

              \n

              Norma<\/p>\n<\/td>\n

              		\n

              Norma<\/p>\n<\/td>\n

              		\n

              Norma<\/p>\n<\/td>\n

              		\n

              Norma<\/p>\n<\/td>\n<\/tr>\n

              \n

              \u2191<\/p>\n<\/td>\n

              		\n

              \u2191<\/p>\n<\/td>\n

              		\n

              +<\/p>\n<\/td>\n

              		\n

              + (negalima atmesti)<\/p>\n<\/td>\n<\/tr>\n

              \n

              Norma<\/p>\n<\/td>\n

              		\n

              \u2191<\/p>\n<\/td>\n

              		\n

              Norma<\/p>\n<\/td>\n

              		\n

              +<\/p>\n<\/td>\n<\/tr>\n<\/tbody>\n<\/table>\n

              3 lentel\u0117. Vitamino B<\/b>12<\/sub><\/b> ir folio r\u016bg\u0161ties stokos diferencin\u0117 diagnostika <\/b><\/p>\n

              \u00a0<\/p>\n

              Sergant megaloblastine anemija be ai\u0161ki\u0173 klinikini\u0173 po\u017eymi\u0173, sunku diferencijuoti, ar ji i\u0161sivyst\u0117 d\u0117l vitamino B12<\/sub> ar d\u0117l folat\u0173 stokos. Patologijas diferencijuoti padeda metilmalonin\u0117s r\u016bg\u0161ties ir homocisteino tyrimas. Jei metilmanolin\u0117s r\u016bg\u0161ties ir homocisteino koncentracijos normalios \u2013 abiej\u0173 r\u016b\u0161i\u0173 anemijos ma\u017eai tik\u0117tinos. Jei abu rodikliai vir\u0161ija norm\u0105\u00a0\u2013 tik\u0117tinesn\u0117 vitamino B12<\/sub> stokos anemija, ta\u010diau negalima atmesti folat\u0173 stokos. Esant padid\u0117jusiam tik homocisteino kiekiui, tik\u0117tiniausias folio r\u016bg\u0161ties tr\u016bkumas. Laboratorini\u0173 tyrim\u0173 interpretacija pateikiama 3\u00a0lentel\u0117je<\/i>.<\/p>\n

              Esant ry\u0161kiam vitamino B12 <\/sub>tr\u016bkumui be kitos akivaizd\u017eios prie\u017easties, tiriami autoantik\u016bnai vidiniam faktoriui. Jie nustatomi sergant piktybine ma\u017eakraujyste\u00a0[18].<\/p>\n

              N\u0117ra nustatyta tiksli vitamino B12<\/sub> normos riba kraujyje. Kada pasireik\u0161 klinikiniai simptomai, priklauso nuo individuali\u0173 organizmo savybi\u0173 ir konkre\u010dios klinikin\u0117s situacijos. Klinikin\u0117je praktikoje, esant ry\u0161kiems ligos simptomams, gydymas pradedamas nedelsiant [19].<\/p>\n

              \u00a0<\/p>\n

              Profilaktika ir gydymas<\/b><\/p>\n

              Lietuvoje galiojan\u010di\u0173 vitamino B12 <\/sub>stokos n\u0117\u0161\u010di\u0173j\u0173 anemijos gydymo gairi\u0173 n\u0117ra. \u0160i patologija yra itin reta, Lietuvos aku\u0161eri\u0173 ginekolog\u0173 draugija n\u0117ra pateikusi gydymo rekomendacij\u0173. Sveika ir subalansuota mityba, kurioje yra pakankamai gyvulin\u0117s kilm\u0117s produkt\u0173, u\u017etikrina normali\u0105 vitamino B12<\/sub> koncentracij\u0105 n\u0117\u0161tumo metu.<\/p>\n

              Did\u017eiojoje Britanijoje pacientams, kuriems n\u0117ra neurologinio deficito, standartin\u0117 doz\u0117 yra 1\u00a0mg hidroksikobalamino \u012f raumenis 3\u00a0k.\/sav. 2 savaites. Pacientams, kuriems yra i\u0161reik\u0161ti neurologiniai simptomai, rekomenduojama leisti 1\u00a0mg \u012f raumenis 2 savaites kiekvien\u0105 dien\u0105.<\/p>\n

              D\u0117l klinikini\u0173 tyrim\u0173 stokos gamintojai nerekomenduoja \u0161io vaisto leisti n\u0117\u0161\u010dioms moterims\u00a0[20], ta\u010diau taip pat n\u0117ra duomen\u0173 apie teratogenin\u012f \u0161io vaisto poveik\u012f\u00a0[21]. Did\u017eiosios Britanijos teratologijos tarnyba i\u0161analizavo 21 atvej\u012f, kai n\u0117\u0161\u010dios moterys buvo gydomos hidroksokobalaminu ir cianokobalaminu. Vaisiaus apsigimim\u0173 da\u017enis statisti\u0161kai patikimai nesiskyr\u0117 nuo bendrosios populiacijos (0\/21, PI 0\u201319,2). D\u0117l plataus pasikliautinojo intervalo ir nedidelio tiriam\u0173j\u0173 skai\u010diaus \u0161i\u0105 studij\u0105 der\u0117t\u0173 vertinti kriti\u0161kai.<\/p>\n

              Karali\u0161kosios aku\u0161eri\u0173 ir ginekolog\u0173 draugijos teigimu, n\u0117ra specifini\u0173 gydymo gairi\u0173, konkre\u010di\u0173 vaisto dozi\u0173, kaip der\u0117t\u0173 gydyti vitamino B12<\/sub> stokos ma\u017eakraujyst\u0119 n\u0117\u0161tumo metu. D\u0117l gydymo reik\u0117t\u0173 spr\u0119sti individualiai, , atsi\u017evelgiant \u012f konkre\u010di\u0105 klinikin\u0119 situacij\u0105 [22].<\/p>\n

              \u00a0<\/b><\/p>\n

              Apibendrinimas<\/b><\/p>\n

              N\u0117\u0161\u010di\u0173j\u0173 ma\u017eakraujyst\u0117 da\u017eniausiai i\u0161sivysto d\u0117l gele\u017eies stokos. Praktikoje da\u017eniausiai gele\u017eies stoka nustatoma atlikus serumo feritino, gele\u017eies tyrimus. Nenusta\u010dius pakitim\u0173, der\u0117t\u0173 galvoti apie retas, ta\u010diau klini\u0161kai reik\u0161mingas prie\u017eastis\u00a0\u2013 folat\u0173 ir vitamino B12<\/sub> stok\u0105. Tr\u016bkstant \u0161i\u0173 med\u017eiag\u0173, motinai i\u0161sivysto anemijos sindromas, o vaisiui padid\u0117ja apsigimim\u0173 rizika. \u0160iais laikais folio r\u016bg\u0161ties stokos anemija n\u0117\u0161tumo metu diagnozuojama re\u010diau d\u0117l profilaktinio \u0161ios med\u017eiagos vartojimo. Nevartojus folio r\u016bg\u0161ties iki pastojimo, j\u0105 reik\u0117t\u0173 prad\u0117ti gerti i\u0161 karto su\u017einojus apie n\u0117\u0161tum\u0105. Vitamino B12<\/sub> stokos ma\u017eakraujyst\u0117 n\u0117\u0161tumo metu yra itin reta patologija. N\u0117ra ai\u0161ki\u0173 diagnostikos ir gydymo gairi\u0173, tod\u0117l n\u0117\u0161\u010diosios prie\u017ei\u016bra turi b\u016bti individualizuota.<\/p>\n

              Gyd. Salom\u0117ja \u0160vabien\u0117, Gyd. Margarita Montrimait\u0117, Doc. dr. Jolita Zakarevi\u010dien\u0117<\/b><\/p>\n

              \u00a0<\/p>\n

              Vilniaus universiteto Medicinos fakulteto Klinikin\u0117s medicinos instituto Aku\u0161erijos ir ginekologijos klinika<\/p>\n

              Vilniaus universiteto ligonin\u0117s Santaros klinik\u0173 Aku\u0161erijos ir ginekologijos centras<\/p>\n

              \u00a0<\/p>\n

              LITERAT\u016aROS \u0160ALTINIAI<\/p>\n

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                \n
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              2. Folic acid for the prevention of neural tube defects. American Academy of Pediatrics. Committee on Genetics. Pediatrics. 1999 Aug;104(2 Pt 1):325\u20137.<\/li>\n
              3. Rogne T, Tielemans MJ, Chong MF-F, Yajnik CS, Krishnaveni GV, Poston L, et al. Maternal vitamin B12 in pregnancy and risk of preterm birth and low birth weight: A systematic review and individual participant data meta-analysis. 2017 Feb 1;185(3):212\u201323.<\/li>\n
              4. Hoffbrand AV, Weir DG. The history of folic acid. Br J Haematol. 2001 Jun;113(3):579\u201389.<\/li>\n
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                \u00a0<\/p>\n","protected":false},"excerpt":{"rendered":"

                Ma\u017eakraujyst\u0117, arba anemija, yra b\u016bkl\u0117, kai organizme suma\u017e\u0117ja hemoglobino ir\u00a0\/\u00a0ar eritrocit\u0173 koncentracija. Eritrocitai yra atsakingi u\u017e deguonies perne\u0161im\u0105 \u017emogaus organizme. Suma\u017e\u0117jus deguonies perna\u0161ai \u012f audinius, kyla j\u0173 hipoksija. Da\u017eniausia ma\u017eakraujyst\u0117s prie\u017eastis\u00a0\u2013 gele\u017eies stoka (96\u00a0proc. atvej\u0173). Folio r\u016bg\u0161ties ir vitamino\u00a0B12<\/sub> stokos anemijos priskiriamos megaloblastini\u0173 anemij\u0173 grupei, kurios pasirei\u0161kia eritrocit\u0173 makrocitoze. \u0160ios r\u016b\u0161ies anemijos da\u017enesn\u0117s besivystan\u010diose \u0161alyse, kuriose maisto kokyb\u0117 yra prastesn\u0117. Lietuvoje maistas yra kokybi\u0161kesnis, \u012fvairesnis, nema\u017eai produkt\u0173 yra papildyti \u012fvairiais vitaminais, folio r\u016bg\u0161timi, vitaminu\u00a0B12<\/sub>, tod\u0117l ma\u017eakraujyst\u0117s atvejai d\u0117l \u0161i\u0173 med\u017eiag\u0173 stokos m\u016bs\u0173 kra\u0161te yra reti. Did\u017eiausi\u0105 rizik\u0105 susirgti turi vaikai iki 5 met\u0173, vaisingo am\u017eiaus ir besilaukian\u010dios moterys\u00a0[1].<\/p>\n","protected":false},"author":1,"featured_media":222,"comment_status":"open","ping_status":"closed","sticky":false,"template":"","format":"standard","meta":{"_acf_changed":false,"footnotes":""},"categories":[27313],"tags":[26258,6834,20710,18909,26302,26252,26304,26297,11793,689,26303,26291,26295,6035,26299,52,26307,7570,26296,26308,26310,18873,26219,26298,26288,10734,26292,415,26300,841,14037,26294,10751,21,26301,26309,26293,138,26306,549,26289,26290,26305],"site":[27309],"post_item_type":[28490],"class_list":["post-221","post","type-post","status-publish","format-standard","has-post-thumbnail","hentry","category-gydymo-naujienos","tag-tukst","tag-apykaita","tag-apzvalga","tag-article","tag-available","tag-birth","tag-cobalamin","tag-defects","tag-deficiency","tag-diagnostika","tag-emedicinemedscapecom","tag-folatai","tag-folic","tag-gydymas","tag-hibbard","tag-maistas","tag-managed","tag-mazakraujyste","tag-neural","tag-neural-tube","tag-neural-tube-defects","tag-overview","tag-pediatrics","tag-preterm","tag-priezastis","tag-product","tag-produktuose","tag-profilaktika","tag-pubmed","tag-raumenis","tag-reference","tag-rezekcija","tag-should","tag-sindromas","tag-supplementation","tag-tube-defects","tag-vaikams","tag-vaistai","tag-vitamin","tag-vitaminas","tag-vitamino-b","tag-vitaminu-b","tag-wwwncbinlmnihgov","site-imunitetas-lt"],"acf":{"post_sites":[27309]},"aioseo_notices":[],"_links":{"self":[{"href":"https:\/\/www.pasveik.lt\/lt\/wp-json\/wp\/v2\/posts\/221","targetHints":{"allow":["GET"]}}],"collection":[{"href":"https:\/\/www.pasveik.lt\/lt\/wp-json\/wp\/v2\/posts"}],"about":[{"href":"https:\/\/www.pasveik.lt\/lt\/wp-json\/wp\/v2\/types\/post"}],"author":[{"embeddable":true,"href":"https:\/\/www.pasveik.lt\/lt\/wp-json\/wp\/v2\/users\/1"}],"replies":[{"embeddable":true,"href":"https:\/\/www.pasveik.lt\/lt\/wp-json\/wp\/v2\/comments?post=221"}],"version-history":[{"count":0,"href":"https:\/\/www.pasveik.lt\/lt\/wp-json\/wp\/v2\/posts\/221\/revisions"}],"acf:term":[{"embeddable":true,"taxonomy":"site","href":"https:\/\/www.pasveik.lt\/lt\/wp-json\/wp\/v2\/site\/27309"}],"wp:featuredmedia":[{"embeddable":true,"href":"https:\/\/www.pasveik.lt\/lt\/wp-json\/wp\/v2\/media\/222"}],"wp:attachment":[{"href":"https:\/\/www.pasveik.lt\/lt\/wp-json\/wp\/v2\/media?parent=221"}],"wp:term":[{"taxonomy":"category","embeddable":true,"href":"https:\/\/www.pasveik.lt\/lt\/wp-json\/wp\/v2\/categories?post=221"},{"taxonomy":"post_tag","embeddable":true,"href":"https:\/\/www.pasveik.lt\/lt\/wp-json\/wp\/v2\/tags?post=221"},{"taxonomy":"site","embeddable":true,"href":"https:\/\/www.pasveik.lt\/lt\/wp-json\/wp\/v2\/site?post=221"},{"taxonomy":"post_item_type","embeddable":true,"href":"https:\/\/www.pasveik.lt\/lt\/wp-json\/wp\/v2\/post_item_type?post=221"}],"curies":[{"name":"wp","href":"https:\/\/api.w.org\/{rel}","templated":true}]}}