Effects of intramuscular and oral mecobalamin in elderly patients with vitamin B12 deficiency / 中国综合临床

ABSTRACT

Objective To investigate the effect of intramuscular and oral mecobalamin on hematologic markers and neurologic signs in elderly patients with vitamin B12 deficiency.Methods One hundred and twenty-six patients with vitamin B12 deficiency who fulfilled the inclusion criteria were randomly divided into 3 groups,42 cases in each,including the intramuscular group (to receive mecobalamin therapy intramuscularly),the oral group ( to receive mecobalamin therapy orally) and the control group ( without mecobalamin therapy).The changes of hematologic markers including hemoglobin (Hb,g/L),mean corpuscular volume (MCV,fl),serum levels of vitamin B12 (ng/L),folate and total homocysteine (Hcy,μmol/L),and neurological signs before and after treatment were compared among these groups.Results Baseline characteristics among the three groups were similar.After a 6-month therapy,there were no differences in any markers in control group patients in comparison to baseline;for patients in the intramuscular group,the blood vitamin B12 levels increased from (139.13 ± 31.57)ng/L to (328.10 ± 42.35 )ng/L (P ＜ 0.001 ).Hcy levels decreased from (36.29 ± 16.23 )μmol/L to ( 18.23 ± 9.85 ) μmol/L ( P ＜ 0.001 ).Hb rose from ( 125.34 ± 16.21 ) g/L to ( 132.79 ± 15.98 )g/L (P =0.037).MCV reduced from (92.98 ±5.35)fl to (87.65 ±5.74)fl (P ＜0.001 ) ;For patients in the oral administration group,the blood vitamin B12 levels increased from ( 138.19 ± 29.95) ng/L to (487.79 ±32.21 ) ng/L ( P ＜ 0.001 ).Hcy levels decreased from ( 33.27 ± 11.51 ) μmol/L to ( 17.49 ± 10.13 ) μmol/L( P ＜ 0.001 ).Hb rose from ( 125.89 ± 17.65 ) g/L to ( 133.46 ± 16.26) g/L ( P =0.041 ).MCV reduced from (93.08 ± 5.10 ) fl to ( 89.29 ± 5.37 ) fl ( P =0.001 ).After the 6-month therapy,there were somewhat improvement in MMSE scores of the intramuscular ( 28.24 ± 3.89 vs.27.85 ± 3.56,P =0.633 ) and the oral groups (27.97 ± 3.77 vs.27.34 ± 3.15,P =0.408 ) compared with baseline,but the differences were not significant.The achilles tendon reflex of the intramuscular ( 1.86 ± 0.67 vs.1.56 ± 0.61,P =0.035 ) and the oral groups ( 1.79 ± 0.64 vs.1.43 ± 0.51,P =0.006 ) were enhanced compared with baseline.Foot vibration sensation of the intramuscular ( 1.35 ± 0.37 vs.1.06 ± 0.41,P =0.001 ) and the oral groups ( 1.24 ± 0.52vs.1.01 ± 0.43,P =0.03) were improved compared with baseline.After treatment,the serum VitB12 concentration in the oral group were higher than that of the intramuscular group ( P ＜ 0.001 ).There were no significant differences in other indexes between the two groups.Conclusion Mecobalamin,administered either intramuscularly or orally,may improve the hematologic markers and neurologic signs in elderly patients with vitamin B12 deficiency.