배 경:우리나라에서는 비타민 B12 결핍성 거대적아구성빈혈에 대한 원인 및 임상소견에 대한 연구가 부족하다. 일반적으로 악성빈혈이 가장 많은 원인으로 여겨지나, 우리나라 특성상 위절제술에 의한 비타민 B12가 부족한 환자가 많을 것으로 사료되어 우리나라에서 비타민 B12 결핍성 거대적아구성 빈혈환자들의 원인 및 임상소견을 분석하였다. 방 법:1992년 7월부터 2004년 10월까지 한림대의료원에서 비타민 B12 결핍성 거대적아구성빈혈로 진단 또는 치료받은 45례의 환자를 대상으로 의무기록 열람을 통한 후향적분석을 하였다. 결 과:대상환자는 45례였고, 환자들의 연령은 65세 (33～85세)였고, 남자가 32례(71.1%)로 많았다. 원인별로는 위절제술을 받았던 경우가 25례(55.6%)였고, 악성빈혈이 8례(18.2%)였다. 연대별로는 2001년 이후 진단되었던 경우가 29례로 가장 많았고 이 환자들 중에 위절제술을 받았던 환자는 20례(69.0%)로 이전 보다 위절제에 의한 비타민 B12 결핍성 거대적아구성빈혈 환자의 비율이 증가하였다. 43례에서 빈혈이 발생하였고, 36례(81.8%)에서 호흡곤란이나 전신쇄약감 등 빈혈과 관련된 증상이 있었다. 일부 신경학적인 증상 및 설사 등의 소화기관 증상 등이 발생했던 환자도 있었다. 6례에서 철 결핍성 빈혈이 동반되었다. 이 중 5례에서 MCV나 MCH의 증가가 없었다. 6례 환자 모두 위절제술을 받았던 환자에서 발생하였다. 결 론:우리나라에서 비타민 B12 결핍성 거대적아구성 빈혈의 원인으로 위절제술이 가장 많은 것으로 나타났다. 비타민 B12 결핍은 빈혈 또는 신경학적인 심한 증상이 발생하나 미리 인지하면 쉽게 치료가 가능하므로, 향후 위 절제술을 받았던 환자에서 비타민 B12 결핍성 거대적아구성 빈혈의 발생을 염두에 두고 환자를 관찰하는 것이 필요할 것으로 사료된다.

Background:Vitamim B12 deficinecy is not a common disease and the causes and clinical findings were not clearly documented in Korea so far. Concerning that vitamin B12 deficiency caused by gastrectomy is not uncommon, we analysized the causes of vitamin B12 deficiency and clinical findings. Methods:We reviewed the clinical records of cases diagnosed as vitamine B12 deficiency megaloblastic anemia in Hallym Medical Center from July, 1992 to Octorber, 2004. Results:Forty five cases were included. Twenty five cases were performed gastrectomy and 8 cases had pernicious anemia, however the causes of 10 cases with vitamin B12 deficiency were not clear. The rate of the cases induced by gastrectomy were increased after 2001 compared with the rate before this point. Six cases were combined with iron deficient anemia. In five of the 6 cases who were combined with iron deficient anemia, the MCV and MCH were not increased. Forty three cases had anemia and anemia-associated symptoms such as dyspnea and weakness. Some of the cases complained diarrhea, numbness, or ataxia. Conclusion:We found that the gastrectomy was the dominant cause of vitamin B12 deficient megaloblastic anemia in this study. We suggest that vitamin B12 deficient megaloblastic anemia should be considered in follow-up of the cases of gastrectomy.

Background:Vitamim B12 deficinecy is not a common disease and the causes and clinical findings were not clearly documented in Korea so far. Concerning that vitamin B12 deficiency caused by gastrectomy is not uncommon, we analysized the causes of vitamin B12 deficiency and clinical findings. Methods:We reviewed the clinical records of cases diagnosed as vitamine B12 deficiency megaloblastic anemia in Hallym Medical Center from July, 1992 to Octorber, 2004. Results:Forty five cases were included. Twenty five cases were performed gastrectomy and 8 cases had pernicious anemia, however the causes of 10 cases with vitamin B12 deficiency were not clear. The rate of the cases induced by gastrectomy were increased after 2001 compared with the rate before this point. Six cases were combined with iron deficient anemia. In five of the 6 cases who were combined with iron deficient anemia, the MCV and MCH were not increased. Forty three cases had anemia and anemia-associated symptoms such as dyspnea and weakness. Some of the cases complained diarrhea, numbness, or ataxia. Conclusion:We found that the gastrectomy was the dominant cause of vitamin B12 deficient megaloblastic anemia in this study. We suggest that vitamin B12 deficient megaloblastic anemia should be considered in follow-up of the cases of gastrectomy.

Vitamin B12 deficiency, Anemia, Gastrectomy