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Ankara Üniversitesi Tıp Fakültesi Aile Hekimliği Anabilim Dalı Polikliniklerine başvuran hastalarda vitamin B12, folat ve ferritin düzeylerinin retrospektif olarak incelenmesi

Retrospective investigation of vitamin B12, folate, and ferritin levels in patients referred to the outpatient clinics of the Department of Family Medicine, Ankara University Faculty of Medicine

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  1. Tez No: 933693
  2. Yazar: KÜBRA BÜYÜKELÇİ SÖĞÜT
  3. Danışmanlar: DOÇ. DR. AYŞE SELDA TEKİNER
  4. Tez Türü: Tıpta Uzmanlık
  5. Konular: Aile Hekimliği, Family Medicine
  6. Anahtar Kelimeler: vitamin B12, cobalamin, folate, folic acid, ferritin, iron
  7. Yıl: 2025
  8. Dil: Türkçe
  9. Üniversite: Ankara Üniversitesi
  10. Enstitü: Tıp Fakültesi
  11. Ana Bilim Dalı: Aile Hekimliği Ana Bilim Dalı
  12. Bilim Dalı: Belirtilmemiş.
  13. Sayfa Sayısı: 102

Özet

Giriş ve Amaç: Mikro besin eksiklikleri tüm dünyada yaygın bir halk sağlığı sorunudur. İnsan vücudunda demir, vitamin B12 ve folat birçok biyolojik reaksiyonda görev alan üç önemli esansiyel besin maddesidir. Ferritin, vücut demir depolarını gösteren en önemli belirteçtir. Folat ve vitamin B12 de çeşitli ortak metabolik yollarda yer almaktadır. B12 vitamini, folat ve ferritin sinir sisteminin gelişimi, kan oluşumu ve çeşitli metabolik işlevler için hayati önem taşımaktadır. Demir, vitamin B12 ve folat eksikliklerinde birçok sisteme ait semptom ve bulgular ortaya çıkabilmektedir. Bu çalışmanın amacı; Ankara Üniversitesi Aile Hekimliği Anabilim Dalı Polikliniklerine herhangi bir nedenle başvuran hastaların vitamin B12, folat ve ferritin düzeylerinin retrospektif olarak incelenmesi ve bu değerlerin cinsiyet, kronik hastalıklar, sigara kullanımı, semptom ve vitamin desteği kullanım durumlarına göre ilişkilerinin değerlendirilmesidir. Gereç ve yöntem: 01 Ocak 2022- 29 Şubat 2024 tarihleri arasında herhangi bir nedenle Aile Hekimliği polikliniklerimize başvuran hastaların retrospektif olarak vitamin B12, folat, ferritin ve diğer hematolojik değerleri ile yaş, cinsiyet, kronik hastalıkları, semptomları, sigara içme durumları, kullandıkları ilaçlar ve bariyatrik cerrahi durumları incelendi. Tanımlayıcı verilerin sunumunda kategorik değişkenler için sayı ve yüzde, süreğen değişkenler için normal dağılıma uygunluk durumuna göre ortalama ve standart sapma veya ortanca ve 1. – 3. çeyreklikler kullanıldı. Kan değerlerinin referans değerlerle ilişkisinin kategorik değişkenler arasındaki dağılım farkını görmek için Ki-Kare Testi kullanıldı. Tüm analizlerde tip 1 hata payı %5 kabul edildi. Bulgular: 3210 kişinin %68,2'si kadındır. Ortalama yaş 34,4 ±13,4'tür. Başvuranların ortalama Hb değeri 14,0 g/dL; MCV değeri 86,1 fL; MCH değeri 28,9 pg/cell; HTC değeri 41,8 %; RBC değeri 4,9 x 10¹²/L; RDW değeri 13,2 %; ferritin değeri 40,5 ng/mL; serum demir değeri 83 µg/dL; TDBK değeri 354,2 µg/dL; TS değeri 24 %; vitamin B12 değeri 335 pg/mL; folat değeri 6,2 ng/mL olarak bulunmuştur. Kişilerin %14,8'inin ferritin değeri; %6,6'sının vitamin B12 değeri ve %14,8'inin folat değeri referans değerlerin altındadır. Diğer yandan kişilerin %10,4'ünün ferritin değeri ve %2,0'sinin vitamin B12 değeri referans değerlerin üzerindedir. Ferritin değeri incelendiğinde kadınların %20,9'unun referans değerin altında ve %2,1'inin referans değerin üzerinde; erkeklerin %1,8'inin referans değerin altında ve %28,2'sinin referans değerin üzerinde olduğu görülmüştür, fark istatistiksel olarak anlamlı düzeydedir (p

Özet (Çeviri)

Background and aim: Micronutrient deficiencies are a widespread public health issue worldwide. In the human body, iron, vitamin B12, and folate are three important essential nutrients that play crucial roles in various biological reactions. Ferritin is the most important indicator of the body's iron stores.Folate and vitamin B12 are also involved in several shared metabolic pathways. Vitamin B12, folate, and ferritin are vital for the development of the nervous system, blood formation, and various metabolic functions. Deficiencies in iron, vitamin B12, and folate can lead to symptoms and signs affecting multiple organ systems. The aim of this study was to retrospectively analyze the levels of vitamin B12, folate, and ferritin in patients presenting to the outpatient clinics of the Department of Family Medicine, Ankara University Faculty of Medicine, for any reason, and to evaluate the relationships between these levels and factors such as gender, chronic diseases, smoking, symptoms, and vitamin supplementation use. Materials and Methods: Between January 1, 2022, and February 29, 2024, a retrospective analysis was conducted on patients who visited our Family Medicine Outpatient Clinics for any reason. The analysis included vitamin B12, folate, ferritin, and other hematological values, as well as age, gender, chronic diseases, symptoms, smoking status, medications, and bariatric surgery history. In the presentation of descriptive data numbers and percentages were used for categorical variables, and means and standard deviations or median and 1st-3rd quartiles were used for continuous variables according to depending on the distribution. The Chi-square test was used to assess the distribution differences of categorical variables in relation to the reference values of the laboratory results. In all analyses, a type 1 error rate of 5% was accepted. Results: Of the 3210 individuals, 68,2% were female. The mean age was 34,4 ± 13,4 years. The mean Hb level of the patients was 14,0 g/dL; MCV 86,1 fL; MCH 28,9 pg/cell; HTC 41,8%; RBC 4,9 x 10¹²/L; RDW 13,2%; ferritin 40,5 ng/mL; serum iron 83 µg/dL; TIBC 354,2 µg/dL; TS 24%; vitamin B12 335 pg/mL; folate 6,2 ng/mL. The ferritin level was below the reference range in 14,8%, vitamin B12 in 6,6%, and folate in 14,8% of the patients. On the other hand, 10,4% had ferritin levels above the reference range, and 2,0% had vitamin B12 levels above the reference range. When examining ferritin levels, 20,9% of females had levels below the reference value, and 2,1% had levels above it; while 1,8% of males had ferritin levels below the reference value and 28,2% had levels above it. This difference was statistically significant (p < 0,001). When examining vitamin B12 levels, 5,9% of females had levels below the reference value, and 2,2% had levels above it; while 8,2% of males had vitamin B12 levels below the reference value, and 1,4% had levels above it. This difference was statistically significant (p=0,014). Regarding folate levels, 13,1% of females and 18,5% of males had folate levels below the reference value. This difference was statistically significant (p < 0,001). When examining ferritin levels in individuals with chronic diseases, 13,8% had levels below the reference value and 10,5% had levels above it; while in individuals without chronic diseases, 15,6% had levels below the reference value and 10.7% had levels above it. The difference was not statistically significant (p=0,333). When examining vitamin B12 levels, 5,1% of individuals with chronic diseases had levels below the reference value and 2,2% had levels above it; while 7,9% of individuals without chronic diseases had levels below the reference value and 1,5% had levels above it. This difference was statistically significant (p=0,003). Regarding folate levels, 11,7% of individuals with chronic diseases had levels below the reference value, while 18,0% of individuals without chronic diseases had levels below it. This difference was statistically significant (p < 0,001). When examining ferritin levels in individuals without symptoms, 13,2% had levels below the reference value and 12,5% had levels above it; while in individuals with symptoms, 17,2% had levels below the reference value and 7,4% had levels above it. This difference was statistically significant (p < 0,001). When examining vitamin B12 levels, 6,5% of individuals without symptoms had levels below the reference value and 2,2% had levels above it; while 6,8% of individuals with symptoms had levels below the reference value and 1,6% had levels above it. This difference was not statistically significant (p = 0,535). When examining folate levels, 14,2% of individuals without symptoms had levels below the reference value, while 15,5% of individuals with symptoms had levels below it. This difference was not statistically significant (p=0,284). Regarding smoking status, in non-smokers, 15,7% had ferritin levels below the reference value and 9,3% had levels above it; in smokers, 12,4% had ferritin levels below the reference value and 13,3% had levels above it. This difference was statistically significant (p=0,006). When examining vitamin B12 levels, 5,6% of non-smokers had levels below the reference value and 1,5% had levels above it; while 8,5% of smokers had vitamin B12 levels below the reference value and 1,5% had levels above it. This difference was statistically significant (p = 0,048). Regarding folate levels, 13,5% of non-smokers had levels below the reference value, while 18,2% of smokers had levels below it. This difference was statistically significant (p=0,005). When examining ferritin levels in individuals not using vitamin and mineral supplements, 14,8% had levels below the reference value and 10,4% had levels above it; while in individuals using supplements, 15.5% had levels below the reference value and 11,7% had levels above it. The difference was not statistically significant (p = 0,887). When examining vitamin B12 levels, 6,7% of individuals not using supplements had levels below the reference value and 1.6% had levels above it; while 1,9% of individuals using supplements had levels below the reference value and 5.8% had levels above it. This difference was statistically significant (p=0,048). When examining folate levels, 15,3% of individuals not using supplements had levels below the reference value, while 6,8% of individuals using supplements had levels below it. This difference was statistically significant (p = 0,005). Conclusion: In our study, we investigated the average values of vitamin B12, folate, and ferritin, as well as their relationships with factors that may affect these values, such as gender, chronic diseases, symptoms, smoking, and medication use. Based on the findings, we conclude that these values can be influenced by various factors. Therefore, in our outpatient clinics, detailed inquiries regarding patients' nutritional histories, medications, chronic diseases, malabsorption disorders, surgical histories, smoking habits, vitamin and mineral supplementation usage, and symptoms, along with physical examination findings, should be conducted for further investigation.

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