恶性贫血：修订间差异
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| ⚫ | '''恶性贫血'''，也稱為'''维生素 |
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'''維生素 B<sub>12</sub> 缺乏貧血'''（{{lang-en|Vitamin B<sub>12</sub> deficiency anemia}}），是指因缺乏[[維生素 B<sub>12</sub>]]造成[[紅血球]]不足的疾病<ref name=NIH2011What>{{cite web|title=What Is Pernicious Anemia?|url=https://www.nhlbi.nih.gov/health/health-topics/topics/prnanmia|website=NHLBI|accessdate=14 March 2016|date=April 1, 2011|archiveurl=https://web.archive.org/web/20160314111724/https://www.nhlbi.nih.gov/health/health-topics/topics/prnanmia|archivedate=14 March 2016}}</ref>，惡性貧血（{{lang-en|Pernicious anemia}}）是造成維生素 B<sub>12</sub> 缺乏的原因之一<ref>{{cite web|title = ICD-10 Version:2015|url = http://apps.who.int/classifications/icd10/browse/2015/en#/D51.0|website = apps.who.int|accessdate = 2015-11-13|archiveurl = https://web.archive.org/web/20151102042503/http://apps.who.int/classifications/icd10/browse/2015/en#/D51.0|archivedate = 2015-11-02}}</ref>。最常見的發病症狀是疲倦<ref name=NIH2011Sign>{{cite web|title=What Are the Signs and Symptoms of Pernicious Anemia?|url=https://www.nhlbi.nih.gov/health/health-topics/topics/prnanmia/signs|website=NHLBI|accessdate=14 March 2016|date=April 1, 2011|archiveurl=https://web.archive.org/web/20160314112837/https://www.nhlbi.nih.gov/health/health-topics/topics/prnanmia/signs|archivedate=14 March 2016}}</ref>，其他症狀有[[呼吸困難]]、皮膚蒼白、胸痛、手腳麻木、平衡感變差、舌頭變得光滑發紅、[[反射 (生理學)|反射]]變差、[[抑鬱]]和意識模糊<ref name=NIH2011Sign/>。若無儘早適當治療，有些症狀可能會永久持續，再治療也不會康復<ref name=NIH2011What/>。 |
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缺乏[[內在因子]]造成的貧血稱為惡性貧血，最常見的成因是[[自體免疫]]問題，也就是患者自己的免疫系統攻擊[[胃]]裡產生內在因子的[[胃壁細胞]]<ref name=NIH2011Cas>{{cite web|title=What Causes Pernicious Anemia?|url=https://www.nhlbi.nih.gov/health/health-topics/topics/prnanmia/causes|website=NHLBI|accessdate=14 March 2016|date=April 1, 2011|archiveurl=https://web.archive.org/web/20160314115517/https://www.nhlbi.nih.gov/health/health-topics/topics/prnanmia/causes|archivedate=14 March 2016}}</ref>；也可能是因為患有遺傳疾病或手術切除了部份的胃<ref name=NIH2011Cas/>引起。其他維生素 B<sub>12</sub> 不足的原因有飲食攝取不足（例如採用[[維根主義]]飲食）、患有[[乳靡瀉]]、感染[[絛蟲]]<ref name=NIH2011Cas/>。一般可透過血液檢查予以釐清，偶爾需要配合骨髓檢查結果來做診斷<ref name=NIH2011Diag>{{cite web|title=How Is Pernicious Anemia Diagnosed?|url=https://www.nhlbi.nih.gov/health/health-topics/topics/prnanmia/diagnosis|website=NHLBI|accessdate=14 March 2016|date=April 1, 2011|archiveurl=https://web.archive.org/web/20160314115225/https://www.nhlbi.nih.gov/health/health-topics/topics/prnanmia/diagnosis|archivedate=14 March 2016}}</ref>。血液檢查結果會呈現{{le|巨母紅血球性貧血|megaloblastic anemia|紅血球體積較大但數量較少}}、少量的[[網狀紅血球]]、維生素 B<sub>12</sub> 濃度偏低和會攻擊內在因子的[[自體抗體]]<ref name=NIH2011Diag/>。 |
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惡性貧血是內在因子缺乏而無法事前預防<ref name=NIH2011Pre>{{cite web|title=How Can Pernicious Anemia Be Prevented?|url=https://www.nhlbi.nih.gov/health/health-topics/topics/prnanmia/prevention|website=NHLBI|accessdate=14 March 2016|date=April 1, 2011|archiveurl=https://web.archive.org/web/20160314105519/https://www.nhlbi.nih.gov/health/health-topics/topics/prnanmia/prevention|archivedate=14 March 2016}}</ref>；其他造成維他命 B<sub>12</sub> 缺乏的原因則可能透過均衡飲食或攝取補充劑來預防<ref name=NIH2011Pre/>。只要簡單注射或服用維他命 B<sub>12</sub> 補充錠劑，就能改善惡性貧血<ref name=NIH2011Tx>{{cite web|title=How Is Pernicious Anemia Treated?|url=https://www.nhlbi.nih.gov/health/health-topics/topics/prnanmia/treatment|website=NHLBI|accessdate=14 March 2016|date=April 1, 2011|archiveurl=https://web.archive.org/web/20160314111520/https://www.nhlbi.nih.gov/health/health-topics/topics/prnanmia/treatment|archivedate=14 March 2016}}</ref>。如果症狀嚴重，典型建議的治療方式為先注射 B<sub>12</sub> <ref name=NIH2011Tx>{{cite web|title=How Is Pernicious Anemia Treated?|url=https://www.nhlbi.nih.gov/health/health-topics/topics/prnanmia/treatment|website=NHLBI|accessdate=14 March 2016|date=April 1, 2011|archiveurl=https://web.archive.org/web/20160314111520/https://www.nhlbi.nih.gov/health/health-topics/topics/prnanmia/treatment|archivedate=14 March 2016}}</ref>，吞嚥錠劑困難的患者，可使用鼻噴劑給藥<ref name=NIH2011Tx/>。這種治療往往會需要持續一生<ref name=NIH2011Prog>{{cite web|title=Living With Pernicious Anemia|url=https://www.nhlbi.nih.gov/health/health-topics/topics/prnanmia/livingwith|website=NHLBI|accessdate=14 March 2016|date=April 1, 2011|archiveurl=https://web.archive.org/web/20160314110059/https://www.nhlbi.nih.gov/health/health-topics/topics/prnanmia/livingwith|archivedate=14 March 2016}}</ref>。 |
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每 1000 人中約有 1 人患有因自體免疫問題引起的惡性貧血<ref name=Andres2012>{{cite journal |vauthors=Andres E, Serraj K | title = Optimal management of pernicious anemia. | journal = [[Journal of Blood Medicine]] | volume = 3 | pages = 97–103 | year = 2012 | pmid = 23028239 | pmc = 3441227 | doi = 10.2147/JBM.S25620 }}</ref>，60 歲以上的族群盛行率約為 2%<ref name=Andres2012/>。惡性貧血較常見於北歐後裔<ref name=Wol2009>{{cite book|title=Professional guide to diseases.|date=2009|publisher=Wolters Kluwer Health/Lippincott Williams & Wilkins|location=Philadelphia|isbn=9780781778992|page=502|edition=9|url=https://books.google.ca/books?id=1h6vu60L6FcC&pg=PA502|archiveurl=https://web.archive.org/web/20160314160441/https://books.google.ca/books?id=1h6vu60L6FcC&pg=PA502|archivedate=2016-03-14}}</ref>，女性患病的比率高於男性<ref>{{cite book|last1=Greer|first1=John P.|title=Wintrobe's clinical hematology.|date=2009|publisher=Wolters Kluwer Health/Lippincott Williams & Wilkins|location=Philadelphia|isbn=9780781765077|page=1157|edition=12th|url=https://books.google.ca/books?id=68enzUD7BVgC&pg=PA1157|archiveurl=https://web.archive.org/web/20160314111810/https://books.google.ca/books?id=68enzUD7BVgC&pg=PA1157|archivedate=2016-03-14}}</ref>。只要治療得宜，多數患者仍可正常生活<ref name=NIH2011What/>；此症患者有較高的機率罹患[[胃癌]]，需要定期追蹤胃的情況<ref name=NIH2011Prog/>。 1849 年，{{link-en|Thomas Addison||湯馬士・愛迪生}}（{{lang-en|Thomas Addison}}）首次留下了此症清楚的記敘<ref>{{cite book|last1=Wailoo|first1=Keith|title=Drawing blood technology and disease identity in twentieth-century America|date=1999|publisher=Johns Hopkins University Press|location=Baltimore, Md.|isbn=9780801870293|page=Chapter 4|edition=Johns Hopkins Paperbacks|chapter-url=https://books.google.ca/books?id=1vYa5ipzJtoC&pg=PT50|chapter=The Corporate "Conquest" of Pernicious Anemia|archiveurl=https://web.archive.org/web/20160314160726/https://books.google.ca/books?id=1vYa5ipzJtoC&pg=PT50|archivedate=2016-03-14}}</ref><ref>{{cite book|title=Dictionary of Medicine|date=2014|publisher=Routledge|isbn=9781135928414|page=404|url=https://books.google.ca/books?id=xD3JAwAAQBAJ&pg=PA404|archiveurl=https://web.archive.org/web/20160314112849/https://books.google.ca/books?id=xD3JAwAAQBAJ&pg=PA404|archivedate=2016-03-14}}</ref>。惡性貧血的英文 "Pernicious anemia" 中，"pernicious (惡性)" 意為「致命的」，因為此症在療法出現前，患者幾乎都必死無疑<ref name=NIH2011What/><ref>{{cite book|last1=Tamparo|first1=Carol|title=Diseases of the Human Body|date=2016|publisher=F.A. Davis|isbn=9780803657915|page=295|url=https://books.google.ca/books?id=eMOCCwAAQBAJ&lpg=PA52&dq=Diseases%20of%20the%20Human%20Body&pg=PA295|archiveurl=https://web.archive.org/web/20160317174529/https://books.google.ca/books?id=eMOCCwAAQBAJ&lpg=PA52&dq=Diseases%20of%20the%20Human%20Body&pg=PA295|archivedate=2016-03-17}}</ref>。 |
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| ⚫ | <!--'''恶性贫血'''，也稱為'''维生素B<sub>12</sub>缺乏贫血'''，是指因為缺乏[[维生素B<sub>12</sub>|维生素B<sub>12</sub>]]而造成[[紅血球]]不足的疾病<ref name=NIH2011What>{{cite web|title=What Is Pernicious Anemia?|url=https://www.nhlbi.nih.gov/health/health-topics/topics/prnanmia|website=NHLBI|accessdate=2016-03-14|date=2011-04-01}}</ref>。常見的症狀是容易疲倦<!--<ref name=NIH2011Sign/>->，其他症狀有[[呼吸困难]]、皮膚蒼白、胸痛、手腳麻木、平衡感變差、舌頭平滑發紅、[[反射 (生理学)|反射]]變差等<ref name=NIH2011Sign>{{cite web|title=What Are the Signs and Symptoms of Pernicious Anemia?|url=https://www.nhlbi.nih.gov/health/health-topics/topics/prnanmia/signs|website=NHLBI|accessdate=2016-03-14|date=2011-04-01|archive-url=https://web.archive.org/web/20160314112837/https://www.nhlbi.nih.gov/health/health-topics/topics/prnanmia/signs|archive-date=2016-03-14|dead-url=yes}}</ref>。若沒有適當治療，有些症狀可能會轉變為持續出現的症狀<ref name=NIH2011What/>。--> |
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==參考資料== |
==參考資料== |
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2020年1月11日 (六) 07:16的版本
維生素 B12 缺乏貧血（英語：Vitamin B12 deficiency anemia），是指因缺乏[[維生素 B12]]造成紅血球不足的疾病[1]，惡性貧血（英語：Pernicious anemia）是造成維生素 B12 缺乏的原因之一[2]。最常見的發病症狀是疲倦[3]，其他症狀有呼吸困難、皮膚蒼白、胸痛、手腳麻木、平衡感變差、舌頭變得光滑發紅、反射變差、抑鬱和意識模糊[3]。若無儘早適當治療，有些症狀可能會永久持續，再治療也不會康復[1]。
缺乏內在因子造成的貧血稱為惡性貧血，最常見的成因是自體免疫問題，也就是患者自己的免疫系統攻擊胃裡產生內在因子的胃壁細胞[4]；也可能是因為患有遺傳疾病或手術切除了部份的胃[4]引起。其他維生素 B12 不足的原因有飲食攝取不足（例如採用維根主義飲食）、患有乳靡瀉、感染絛蟲[4]。一般可透過血液檢查予以釐清，偶爾需要配合骨髓檢查結果來做診斷[5]。血液檢查結果會呈現紅血球體積較大但數量較少、少量的網狀紅血球、維生素 B12 濃度偏低和會攻擊內在因子的自體抗體[5]。
惡性貧血是內在因子缺乏而無法事前預防[6]；其他造成維他命 B12 缺乏的原因則可能透過均衡飲食或攝取補充劑來預防[6]。只要簡單注射或服用維他命 B12 補充錠劑，就能改善惡性貧血[7]。如果症狀嚴重，典型建議的治療方式為先注射 B12 [7]，吞嚥錠劑困難的患者，可使用鼻噴劑給藥[7]。這種治療往往會需要持續一生[8]。
每 1000 人中約有 1 人患有因自體免疫問題引起的惡性貧血[9]，60 歲以上的族群盛行率約為 2%[9]。惡性貧血較常見於北歐後裔[10]，女性患病的比率高於男性[11]。只要治療得宜，多數患者仍可正常生活[1]；此症患者有較高的機率罹患胃癌，需要定期追蹤胃的情況[8]。 1849 年，湯馬士・愛迪生（英語：Thomas Addison）首次留下了此症清楚的記敘[12][13]。惡性貧血的英文 "Pernicious anemia" 中，"pernicious (惡性)" 意為「致命的」，因為此症在療法出現前，患者幾乎都必死無疑[1][14]。
參考資料
- ^ 1.0 1.1 1.2 1.3 What Is Pernicious Anemia?. NHLBI. April 1, 2011 [14 March 2016]. （原始内容存档于14 March 2016）.
- ^ ICD-10 Version:2015. apps.who.int. [2015-11-13]. （原始内容存档于2015-11-02）.
- ^ 3.0 3.1 What Are the Signs and Symptoms of Pernicious Anemia?. NHLBI. April 1, 2011 [14 March 2016]. （原始内容存档于14 March 2016）.
- ^ 4.0 4.1 4.2 What Causes Pernicious Anemia?. NHLBI. April 1, 2011 [14 March 2016]. （原始内容存档于14 March 2016）.
- ^ 5.0 5.1 How Is Pernicious Anemia Diagnosed?. NHLBI. April 1, 2011 [14 March 2016]. （原始内容存档于14 March 2016）.
- ^ 6.0 6.1 How Can Pernicious Anemia Be Prevented?. NHLBI. April 1, 2011 [14 March 2016]. （原始内容存档于14 March 2016）.
- ^ 7.0 7.1 7.2 How Is Pernicious Anemia Treated?. NHLBI. April 1, 2011 [14 March 2016]. （原始内容存档于14 March 2016）.
- ^ 8.0 8.1 Living With Pernicious Anemia. NHLBI. April 1, 2011 [14 March 2016]. （原始内容存档于14 March 2016）.
- ^ 9.0 9.1 Andres E, Serraj K. Optimal management of pernicious anemia.. Journal of Blood Medicine. 2012, 3: 97–103. PMC 3441227
. PMID 23028239. doi:10.2147/JBM.S25620.
- ^ Professional guide to diseases. 9. Philadelphia: Wolters Kluwer Health/Lippincott Williams & Wilkins. 2009: 502. ISBN 9780781778992. （原始内容存档于2016-03-14）.
- ^ Greer, John P. Wintrobe's clinical hematology. 12th. Philadelphia: Wolters Kluwer Health/Lippincott Williams & Wilkins. 2009: 1157. ISBN 9780781765077. （原始内容存档于2016-03-14）.
- ^ Wailoo, Keith. The Corporate "Conquest" of Pernicious Anemia. Drawing blood technology and disease identity in twentieth-century America Johns Hopkins Paperbacks. Baltimore, Md.: Johns Hopkins University Press. 1999: Chapter 4. ISBN 9780801870293. （原始内容存档于2016-03-14）.
- ^ Dictionary of Medicine. Routledge. 2014: 404. ISBN 9781135928414. （原始内容存档于2016-03-14）.
- ^ Tamparo, Carol. Diseases of the Human Body. F.A. Davis. 2016: 295. ISBN 9780803657915. （原始内容存档于2016-03-17）.
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