胃增生性息肉与自身免疫性化生性萎缩性胃炎的相关性分析  

The association of gastric hyperplastic polyps and autoimmune metaplastic atrophic gastritis

作　　者：胡海一[1] 冀明[1] 陈光勇[2] 张澍田[1] Hu Haiyi;Ji Ming;Chen Guangyong;Zhang Shutian(Department of Gastroenterology,Beijing Friendship Hospital,Capital Medical University,National Clinical Research Center for Digestive Diseases,Beijing Digestive Disease Center,Beijing Key Laboratory for Precancerous Lesion of Digestive Diseases,Beijing 100050,China;Department of Pathology,Beijing Friendship Hospital,Capital Medical University,National Clinical Research Center for Digestive Diseases,Beijing 100050,China)

机构地区：[1]首都医科大学附属北京友谊医院消化科国家消化系统疾病临床医学研究中心北京市消化疾病中心消化疾病癌前病变北京市重点实验室,100050 [2]首都医科大学附属北京友谊医院病理科国家消化系统疾病临床医学研究中心,100050

出　　处：《中华消化内镜杂志》2020年第8期573-577,共5页Chinese Journal of Digestive Endoscopy

摘　　要：目的:探讨胃增生性息肉与自身免疫性化生性萎缩性胃炎的相关性。方法:回顾性分析2011年1月—2017年6月于首都医科大学附属北京友谊医院内镜中心行内镜切除术的56例胃增生性息肉患者,包括17例伴肿瘤性改变和39例不伴肿瘤性改变的患者,分析患者血清学、内镜表现和病理的特点。结果:男22例、女34例,年龄(61.88±9.01)岁。空腹胃泌素升高率50.0%(28/56),血清抗壁细胞抗体(anti-parietal cell antibody,PCA)阳性率62.5%(35/56),贫血率37.5%(21/56),幽门螺旋杆菌阴性率64.3%(36/56)。与血清PCA阴性患者相比,血清PCA阳性患者以女性多见( P=0.034),易发生高胃泌素血症( P<0.001)、贫血( P=0.001)、多发GHPs( P=0.019),且以血清铁缺乏为主( P=0.044)。35例血清PCA阳性患者共108枚息肉,胃底、体91枚(84.3%)、胃窦17枚(15.7%, P=0.005);21例贫血患者共63枚息肉,胃底、体54枚(85.7%)、胃窦9枚(14.3%, P=0.075)。56例患者共142枚增生性息肉,73.2%(104/142)为带蒂息肉,69.0%(98/142)为"草莓状"息肉。17例伴肿瘤性改变中,6例高分化腺癌、2例中分化腺癌、3例高级别异型增生、6例低级别异型增生。 结论:胃增生性息肉与自身免疫性化生性萎缩性胃炎有关,可能在其基础上向肿瘤性改变转化。Objective To study the association of gastric hyperplastic polyps(GHPs)and autoimmune metaplastic atrophic gastritis(AMAG).Methods A retrospective analysis was conducted on data regarding 56 GHPs patients who underwent endoscopic resection at Beijing Friendship Hospital,Capital Medical University from January 2011 to June 2017,including 17 patients with neoplasia and 39 patients without neoplasia.The characters of GHPs in serology,gastroscopic manifestation and pathology were analyzed.Results The data of patients including 34 females and 22 males were collected in the study.The age was 61.88±9.01 years.The increase rate of fast serum gastrin was 50.0%(28/56),the positive rate of serum gastric parietal cell antibody(PCA)was 62.5%(35/56),the rate of anemia was 37.5%(21/56),and the negative rate of Helicobacter pylori was 64.3%(36/56).Compared with the patients with negative serum PCA,the patients with positive serum PCA were mostly female(P=0.034),prone to hypergastrinemia(P<0.001),anemia(P=0.001),especially iron deficiency anemia(P=0.044),and multiple GHPs(P=0.019).There were 108 GHPs in 35 PCA positive patients,GHPs were more distributed in the gastric fundus and corpus(91/108,84.3%)than in antrum(17/108,15.7%,P=0.005).There were 63 GHPs in 21 anemia patients,54(85.7%)GHPs located in the gastric fundus and corpus,and 9(14.3%)GHPs in antrum(P=0.075).There were total 142 GHPs in 56 patients,73.2%GHPs(104/142)were pedunculated,69.0%(98/142)were"strawberry-like"polyps.Among 17 patients of GHP with neoplasia,there were 6 high differentiated adenocarcinomas,2 moderate adenocarcinomas,3 high grade dysplasia,and 6 low grade dysplasia.Conclusion GHPs are associated with AMAG.GHP with AMAG is probably one of the reasons of neoplastic transformation.

关 键 词：息肉 胃增生性息肉 自身免疫性化生性萎缩性胃炎 高胃泌素血症 

分 类 号：R573.32[医药卫生—消化系统]