The ClinicianThe ClinicianКлиницист1818-83382412-8775Publishing House ABV Press27210.17650/1818-8338-2016-10-3-15-25REVIEWОБЗОРMODERN DIAGNOSTIC AND TREATMENT OF VITAMIN В12 DEFICIENCYСОВРЕМЕННЫЕ ВОЗМОЖНОСТИ ДИАГНОСТИКИ И ЛЕЧЕНИЯ ДЕФИЦИТА ВИТАМИНА В12KrasnovskiyA. L.КрасновскийА. Л.
Russian Federation

Department of Internal Medicine of the Faculty of Medical and Biological,

1 Ostrovityanova St., Moscow 117997

Кафедра внутренних болезней медико-биологического факультета, 

117997 Москва, ул. Островитянова, 1

alexkras758@yandex.ruGrigor’ievS. P.ГригорьевС. П.
Russian Federation

Department of Internal Medicine of the Faculty of Medical and Biological,

1 Ostrovityanova St., Moscow 117997

Кафедра внутренних болезней медико-биологического факультета, 

117997 Москва, ул. Островитянова, 1

AlyokhinaR. M.АлёхинаР. М.
Russian Federation

Department of Internal Medicine of the Faculty of Medical and Biological,

1 Ostrovityanova St., Moscow 117997

Кафедра внутренних болезней медико-биологического факультета, 

117997 Москва, ул. Островитянова, 1

EzhovaI. S.ЕжоваИ. С.
Russian Federation

Department of Internal Medicine of the Faculty of Medical and Biological,

1 Ostrovityanova St., Moscow 117997

Кафедра внутренних болезней медико-биологического факультета, 

117997 Москва, ул. Островитянова, 1

ZolkinaI. V.ЗолкинаИ. В.
Russian Federation

Department of Internal Medicine of the Faculty of Medical and Biological,

1 Ostrovityanova St., Moscow 117997

Кафедра внутренних болезней медико-биологического факультета, 

117997 Москва, ул. Островитянова, 1

LoshkarevaE. O.ЛошкареваЕ. О.
Russian Federation

Department of Internal Medicine of the Faculty of Medical and Biological,

1 Ostrovityanova St., Moscow 117997

Кафедра внутренних болезней медико-биологического факультета, 

117997 Москва, ул. Островитянова, 1

State Budgetary Educational Institution N.I. Pirogov Russian National Research Medical University of the Ministry of Health of RussiaФГБОУ ВО «РНИМУ им. Н.И. Пирогова» Минздрава России1507201610315250101201701012017Copyright ©; 2016, Krasnovskiy A.L., Grigor’iev S.P., Alyokhina R.M., Ezhova I.S., Zolkina I.V., Loshkareva E.O.Copyright ©; 2016, Красновский А.Л., Григорьев С.П., Алёхина Р.М., Ежова И.С., Золкина И.В., Лошкарева Е.О.2016Krasnovskiy A.L., Grigor’iev S.P., Alyokhina R.M., Ezhova I.S., Zolkina I.V., Loshkareva E.O.Красновский А.Л., Григорьев С.П., Алёхина Р.М., Ежова И.С., Золкина И.В., Лошкарева Е.О.https://creativecommons.org/licenses/by/4.0https://klinitsist.abvpress.ru/Klin/article/view/272

An article reflects modern concepts of the etiology of vitamin B12 deficiency including medication-induced conditions. Particular attention is paid to diagnostic algorithm in case of overt and latent forms of deficit. As the method of choice for the diagnosis of vitamin B12 deficiency it is recommended to determine the level of holotranscobalamin and use additional methods for detecting metabolic deficiency of vitamin B12 – to study the levels of homocysteine and methylmalonic acid. Diagnostic algorithms for patients with clinical suspicion of vitamin B12 deficiency and the presence of subclinical deficiency. We reviewed the possibility of vitamin B12 oral preparations to correct low levels of cobalamin in asymptomatic patients, as well as maintenance therapy in patients with clinical signs of vitamin B12 deficiency.

В статье отражены современные представления об этиологии дефицита витамина В12, в том числе медикаментозно индуцированного. Особое внимание уделено диагностическим алгоритмам в случае явных и латентных форм дефицита. В качестве метода выбора для диагностики дефицита витамина В12 рекомендуется использовать определение уровня холотранскобаламина, а в качестве дополнительных методов выявления метаболического дефицита витамина В12 – измерение уровней гомоцистеина или метилмалоновой кислоты. Представлены алгоритмы ведения больных с клиническим подозрением на дефицит витамина В12 и с наличием субклинического дефицита. Рассмотрена возможность применения пероральных препаратов витамина В12 для коррекции низкого уровня кобаламина у бессимптомных пациентов, а также в качестве поддерживающей терапии у больных с клиническими проявлениями дефицита витамина В12.

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