Dr. Gergana Nikolova, MD: Vegans feem ntau raug mob ntshav qab zib

Cov txheej txheem:

Dr. Gergana Nikolova, MD: Vegans feem ntau raug mob ntshav qab zib
Dr. Gergana Nikolova, MD: Vegans feem ntau raug mob ntshav qab zib
Anonim

Kev Tiv Thaiv Kev Tshaj Tawm ntawm "Granulocytopoiesis hauv cov neeg mob uas mob myeloid leukemia nyob rau hauv kev saib xyuas hnyav" ntawm Lavxias Academy ntawm Kev Kho Mob Sciences, Moscow.

Tau ntau xyoo nws yog lub taub hau thiab tus pab laus ntawm Kws Kho Mob ntawm University of St. Kliment Ohridski. Koom nrog cov rooj sib tham kho mob thoob ntiaj teb loj, muaj ntau yam kev tshaj tawm. Nws kuj tau ua tiav cov kev tshwj xeeb ntxiv: Fabkis National Association of Hematology - Rein Danou Foundation Award, University of Paris - VII, Kev Tshawb Fawb Txog Kev Tshawb Fawb: "Kev Ntsuas Ntsuas thiab Pathogenesis hauv Polycythemia Vera, Lub Tsev Kawm Ntawv ntawm Hematology, Saint Louis Tsev Kho Mob, Laboratory ntawm biology ntawm hematopoietic hlwb ntawm Haim Center, qhov project scientific: "Retinoic acid thiab erythroid sib txawv hauv polycythemia vera".

Peb tab tom tham nrog Dr. Gergana Nikolova txog kev kuaj mob thiab kev kho mob ntawm pernicious anemia, uas tau qhia hauv vitamin B12 deficiency.

Dr. Nikolova, peb paub ntau ntxiv txog hlau deficiency anemia, tab sis tsawg heev txog pernicious anemia. Thov qhia peb seb hom kab mob ntshav no yog dab tsi?

- Pernicious anemia yog los ntawm pab pawg megaloblastic anemias thiab qhia nyob rau hauv vitamin B12 deficiency. Yuav kom nkag siab txog cov ntsiab lus ntawm vitamin B12 deficiency anemia, nws yog ib qho tsim nyog yuav tsum paub meej tias cov vitamin no yog dab tsi, nws lub luag haujlwm yog dab tsi hauv kev ua haujlwm ntawm tib neeg lub cev.

Tus kab mob cuam tshuam nrog vitamin B12 tsis txaus tau piav qhia thaum ntxov li xyoo 19th raws li pernicious anemia (malignant anemia) los ntawm tus kws kho mob Askiv Thomas Addison. Nws yuav siv sij hawm ntev mus rau hauv paus ntawm tus kab mob. Hauv xyoo 1948, lawv tau tshuaj xyuas cov tshuaj tau muab rho tawm los ntawm daim siab nyoos, uas txij li xyoo 1928 tau siv los kho tus mob ntshav qab zib pernicious. Nws yog hu ua cobalamin lossis vitamin B12. Yog li, txij li xyoo 1950, vitamin B12 tau tsim tawm thiab cov kab mob phem tau swb lawm.

Nyob rau xyoo tom ntej, lub luag haujlwm ntawm vitamin B12 rau txhua tus tsiaj txhu tau qhia meej ib kauj ruam. Nws tsis tuaj yeem ua rau muaj kev cuam tshuam ntawm cov txheej txheem ntawm kev sib txuas ntawm cov tseem ceeb nucleic acids (DNA, RNA) thiab tom qab ntawd ntawm tag nrho cov protein tseem ceeb hauv lub cev, tsim nyog rau kev ua haujlwm ntawm lub hlwb thiab qaum qaum, ntawm tag nrho lwm yam kabmob.

Nws hloov tawm tias vitamin B12 ua haujlwm nrog folic acid (vitamin B9). Cov txheej txheem kev sib cuam tshuam ntawm ob cov vitamins thiab lawv lub luag haujlwm hauv kev ua haujlwm zoo ntawm tag nrho cov ntaub so ntswg thiab lub cev yog qhov nyuaj.

Anemias uas tsim nyob rau hauv qhov chaw ntawm vitamin B12 thiab folic acid deficiency yog hu ua megaloblastic anemias. Lawv yog tus cwj pwm los ntawm qhov loj thiab qhov siab tshaj plaws saturated nrog hemoglobin erythrocytes, ib qho kev them nyiaj yug los ua kom lub ntsej muag loj dua thaum ua lawv lub luag haujlwm tseem ceeb - nqa oxygen, tsim nyog rau kev ua haujlwm tag nrho ntawm txhua lub cell hauv lub cev.

Dab tsi yog qhov ua rau muaj vitamin B12 tsis txaus?

- Lub ntsiab yog vim li cas rau kev loj hlob ntawm anemia yog vitamin B12 deficiency, uas feem ntau nrog folic acid deficiency

Kev tsis txaus ntseeg nrog kev noj zaub mov tsis zoo uas cov nqaij thiab nqaij tsis tuaj. Hom ntshav qab zib no tshwm sim ntau zaus hauv cov neeg tsis noj nqaij thiab vegans vim tias lawv cov zaub mov tsis muaj cov zaub mov no. Nws yog categorically txaus ntshai rau cov poj niam cev xeeb tub uas ua raws li vegan thiab neeg tsis noj nqaij noj.

Lwm yam ua rau vitamin B12 deficiency anemia yog cuam tshuam nrog cov theem ntawm kev nqus ntawm cobalamin: kev tsis haum xeeb hauv cov hnyuv (mob inflammatory kab mob; kev phais phais), mob pancreatitis.

Tsis tshua muaj qhov ua rau vitamin B12 deficiency anemia yog cov kab mob hauv lub cev cuam tshuam nrog cobalamin metabolism. Ntses tapeworm kuj yog qhov ua rau.

Peb yuav tsum hais txog macrocytic, megaloblastic anemias pom nyob rau hauv kev kho mob nrog tshuaj tua kab mob uas thaiv kev ua ntawm cobalamin thiab folic acid ntawm qib ntawm cov metabolism hauv cell.

Los ntawm cov txheej txheem dab tsi ua rau qhov mob ntshav qab zib no tshwm sim hauv lub cev?

- Vitamin B12 thiab folic acid tsis txaus cuam tshuam rau txhua lub cev thiab lub cev hauv lub cev. Ua ntej tshaj plaws, lawv cuam tshuam rau cov pob txha pob txha, qhov twg cov txheej txheem ntawm kev sib txawv thiab kev loj hlob ntawm erythrocytes raug thaiv tag nrho.

Lawv lub neej luv luv thiab lawv tawg sai heev, thaum ntxov ntawm lawv txoj kev loj hlob. Cov txheej txheem tib yam tau pom hauv granulocytes. Lawv tus lej txo qis, lawv cov nuclei ua hypersegmented. Lawv lub luag haujlwm tseem ceeb yog ua txhaum - tiv thaiv kab mob thiab kab mob fungal.

Kev txo qis ntawm cov platelets thiab nyiam los ntshav ntawm daim tawv nqaij tau pom. Cobalamin thiab folate tsis muaj peev xwm ua ntej ua rau puas tsuaj sai sai ntawm epithelial hlwb ntawm daim tawv nqaij, mucous daim nyias nyias ntawm lub qhov ncauj, plab, hnyuv me, ua pa system, tso zis, genitalia ntawm ob leeg poj niam thiab cov txiv neej. Cov menyuam yaus ntawm cov niam txiv tsis muaj vitamin B12 muaj ntshav qab zib thaum ntxov - txog 3 xyoos. Kev tsis haum ntawm lub plab yog qhov thib ob feem ntau ua rau vitamin B12 deficiency anemia.

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Koj hais cov poj niam cev xeeb tub. Yuav ua li cas pernicious anemia ua mob rau tus poj niam cev xeeb tub nrog qhov tsis txaus no?

- Cov teeb meem uas tuaj yeem tshwm sim thaum cev xeeb tub yog qhov hnyav thiab hnyav.

Kev tsis txaus ntawm cobalamin thiab folate hauv niam tuaj yeem ua rau kev rho menyuam ntxov. Folate thiab cobalamin yog koom nrog hauv kev tsim cov fetal neural raj. Thaum ntxov prophylaxis nrog folic acid txo qhov tshwm sim ntawm neural raj tsis xws luag - encephaly, meningocele, encephalocele thiab spina bifida txog li 70%.

Cleft palate thiab qhov ncauj qhov ntswg tuaj yeem zam tau los ntawm folic acid prophylaxis. Kev sib raug zoo ntawm vitamin B12 thiab folic acid deficiency hauv niam yog qhov tseeb. Qhov kev pheej hmoo ntawm qhov tsis txaus no nce ntxiv hauv cov niam uas muaj ntshav qab zib, thaum kho nrog cov tshuaj tiv thaiv kab mob thiab lwm yam tshuaj tua kab mob antifolate.

Muaj cov ntaub ntawv tshawb fawb txog qhov hnyav thiab ntev vitamin B12 thiab folate deficiency uas tuaj yeem cuam tshuam rau pob txha tsim.

Cov kab mob dab tsi tshwm sim thaum muaj qhov tsis txaus ntawm cov neeg laus?

- Kev koom tes ntawm cov vitamin B12 ncaj qha rau hauv kev tsim kho, metabolism thiab kho cov hlab ntsha hauv lub paj hlwb yog qhov ua rau muaj kev cuam tshuam loj heev thaum lub sij hawm tsis txaus - ob tog peripheral neuropathy lossis degeneration (demyelination) ntawm tus txha caj qaum.

Tsis tshua muaj, atrophy ntawm cov hlab ntsha optic thiab kev tsis haum xeeb hauv lub paj hlwb yuav raug pom. Cov kev hloov no yog txuam nrog paresthesias (tshem tawm) ntawm ob txhais ceg, leeg tsis muaj zog, taug kev nyuaj. Thaum lub hlwb raug cuam tshuam, kev nco thiab kev nyuaj siab raug pom. Folic acid deficiency ua rau qhov kev hloov pauv zuj zus ntxiv thiab ua rau muaj kev tsis txaus siab.

vitamin B12 absorbed hauv lub cev li cas?

- Txoj kev ntawm cov vitamin B12 uas nkag mus rau hauv lub cev nrog zaub mov yuav tsum ua raws - kev nqus ntawm cobalamin. Ob txoj kev nqus tau tau piav qhia - passive thiab nquag. Passive absorption tshwm sim sib npaug ntawm duodenum thiab cov hnyuv me. Nws tsis zoo thiab tsuas yog muab 1% ntawm kev noj haus cobalamin xwb. Passive resorption ntawm cobalamin kuj tuaj yeem tshwm sim los ntawm cov mucous hauv lub qhov ntswg thiab hauv qab tus nplaig.

Kev nqus dej yog qhov tseem ceeb rau lub cev. Qhov no yog lub cev ib txwm ua los ntawm cov vitamin B12 nkag mus rau hauv lub cev. Active absorption yog paub los ntawm lub gastric intrinsic (sab hauv) yam thiab dhau los ntawm ob peb theem. Thawj kauj ruam yog tso tawm cobalamin hauv cov zaub mov los ntawm cov protein complexes los ntawm enzymes hauv plab, duodenum, thiab cov hnyuv me.

Nyob rau theem thib ob, cobalamin nrawm nrawm nrog cov kua qaub glycoprotein xa mus rau plasma Transcobalamin-I. Cov proteins no yog isoforms ntawm cobalamin. Lawv tuaj yeem pom hauv cov qaub ncaug, kua txiv hmab txiv ntoo, mis nyuj thiab lwm yam kua hauv lub cev. Lawv tau encoded los ntawm ib tug tib noob (TCN1).

Cov kauj ruam tom ntej no suav nrog kev degradation ntawm haptocorins rau cabalamine los ntawm pancreatic enzyme tyrosine.

Qhov kawg, qhov tseem ceeb tshaj plaws yog kev khi ntawm cobalamin rau qhov tseem ceeb (IF) - qhov no yog glycoprotein uas yog encoded los ntawm cov noob ntawm chromosome 11q13. Intrinsic yam yog tsim nyob rau hauv parietal hlwb ntawm fundus thiab lub cev ntawm lub plab. Lub complex Intrinsic factor (IF) - cobalamin yog resistant rau digestive enzymes tsis zoo li dawb IF.

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theem tom ntej ntawm kev nqus yuav tshwm sim nyob rau theem ntawm cov hnyuv me, qhov twg cov complex txuas rau cov receptors tshwj xeeb. Nyob rau hauv congenital autosomal recessive megaloblastic anemia, tej zaum yuav muaj ib tug tsis xws luag nyob rau hauv lub receptors ntawm lub hlwb ntawm lub plab hnyuv mucosa. Cov txheej txheem no cuam tshuam nrog cov hnyuv me malabsorption ntawm cobalamin.

Muaj ib qho protein thib peb (LRP2) uas ua kom cov cobalamin complex thiab receptors hauv hlwb ntawm cov hnyuv

Nyob rau hauv cov hnyuv, yog tias degraded tom qab li 6 teev.

theem kawg ntawm kev nqus tau xaus nrog cov tsos ntawm cobalamin txuam nrog kev ruaj khov TrancobalaminII-TCII complex - lub ntsiab thauj protein. Nws yog synthesized los ntawm lub siab thiab lwm yam ntaub so ntswg, nrog rau cov macrophages, endothelial thiab tej zaum cov hnyuv me. Nws yooj yim tso tawm cobalamin hauv cov pob txha pob txha, placenta, thiab lwm yam ntaub so ntswg.

Thaum kawm txog cov txheej txheem ntawm kev nqus ntawm cobalamin, cov caj ces txawv txav tau pom nyob rau hauv cov molecule ntawm lub hauv paus, nyob rau hauv cov molecules ntawm cov receptors tshwj xeeb nyob rau hauv cov hnyuv me, uas characterize lub congenital autosomal recessive megaloblastic anemia.

Vim li cas vitamin B12 tseem ceeb rau peb lub cev?

- Vitamin B12, los yog cobalamin raws li peb kuj hu nws, yog dej-soluble vitamin nrog loj thiab complex molecular qauv ntawm tag nrho cov vitamins. Nws ua lub luag haujlwm tseem ceeb heev thaum lub sijhawm tsim cov qe ntshav liab, cell metabolism, lub paj hlwb ua haujlwm, DNA tsim, thyroid noj qab haus huv, kev zom zaub mov thiab kev nqus ntawm cov zaub mov, cov tshuaj hormones adrenal, thiab lwm yam. Ib qho ntawm nws cov yam ntxwv tseem ceeb tshaj plaws yog nws txoj kev koom tes hauv kev tsim cov qe ntshav liab thiab kev nqus hlau hauv lub cev.

Cov tsos mob ntawm pernicious anemia yog dab tsi? Puas yog lawv txawv ntawm lwm hom mob ntshav qab zib?

- Cov tsos mob zoo ib yam li hauv peb cov kab mob uas paub zoo - qaug zog, tsaug zog, tsis muaj peev xwm ua haujlwm txhua hnub, tsis muaj kev xav.

Kev cuam tshuam hauv lub paj hlwb yog qhov hnyav dua, vim hais tias ntawm no tsis yog tsuas yog tsis muaj oxygen xwb, tab sis kuj hais txog kev kho cov paj hlwb lawv tus kheej. Thaum tsis muaj vitamin B12, ob lub hlwb hauv lub hlwb thiab hauv lub paj hlwb peripheral tsis tuaj yeem tsim dua tshiab. Vitamin B12 nrog rau folic acid (vitamin B9) yuav tsum tau kuaj xyuas kom raug vim tias lawv feem ntau mus ua ke abnormality.

Cov kev ntsuam xyuas dab tsi tau ua kom paub meej tias qhov kev kuaj mob ntawm pernicious anemia?

- Cov neeg mob uas muaj ntshav tsis txaus yog kuaj pom tom qab kev tshawb nrhiav - ua tiav cov ntshav suav, vitamin B12, folate (vitamin B9), hlau metabolism (cov ntshav hlau thiab tag nrho cov hlau-txheej txheem), ferritin, erythrocyte morphology. Yog hais tias anemia tshwm sim thaum muaj hnub nyoog ntxov raug kuaj xyuas, cov caj ces txawv txav thiab, raws li, thaum ntxov autoimmune gastritis yog nrhiav.

Nyob rau hauv tag nrho cov anemias, tag nrho cov ntshav suav thiab reticulocytes raug kuaj xyuas kom pom tias dab tsi yog lub peev xwm ntawm cov pob txha pob txha nyob rau hauv cov nqe lus ntawm erythropoiesis. Feem ntau, hauv cov ntshav tsis muaj hlau tsis txaus uas tshwm sim tom qab cov ntshav poob, muaj kev ua haujlwm loj heev. Raws li rau vitamin B12, muaj cov txheej txheem proliferative ib txwm tsis tuaj yeem tshwm sim thiab qhov kev ua haujlwm no raug txo qis.

Qhov chaw ntawm vitamin B12 rau tib neeg yog zaub mov. Rau peb, cov zaub mov tseem ceeb yog tau los ntawm cov tsiaj. Qhov loj tshaj plaws yog pom nyob rau hauv daim siab - ib tug depot ntawm cobalamin thiab nyob rau hauv cov nqaij. Vitamin B12 muaj tsawg heev nyob rau hauv cov ntses, shellfish, nqaij qaib, khoom noj siv mis thiab qe. Vitamin B12 tsis pom muaj nyob rau hauv zaub thiab txiv hmab txiv ntoo thiab lwm yam khoom noj uas tsis yog tsiaj keeb kwm.

Kev kho mob dab tsi rau cov neeg mob ntshav qab zib pernicious?

- Kev kho mob tsis tau hloov txij li xyoo 1950. Nws yog siv nrog cobalamin (vitamin B12) intramuscularly. Qhov koob tshuaj yog txiav txim los ntawm qhov hnyav ntawm qhov tsis txaus cobalamin.

Thaum mob autoimmune gastritis, kev kho corticosteroid kuj tseem siv tau, tab sis kev txhawb nqa tseem nyob.

Nyob rau hauv cov kev kho mob, nws yuav tsum tsis txhob tsis saib xyuas qib ntawm folic acid thiab, yog tias tsim nyog, kom suav nrog xws li kev kho mob.

Nyob rau hauv xyoo tas los no, kev npaj rau qhov ntswg thiab kev tswj hwm sublingual kuj muaj. Tom qab ua raws li cov txheej txheem nyuaj ntawm kev nqus ntawm vitamin B12, cov kev npaj no tsuas yog tsim nyog rau kev kho mob. Kev kho mob tseem ceeb yog kev tswj hwm intramuscular ntawm vitamin B12.

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