自身免疫性胃炎40例误诊分析  

Misdiagnosed Analysis of 40 Patients with Autoimmune Gastritis

作　　者：杨洋[1] 付新新[1] 罗晓旭 郝英霞[1] YANG Yang;FU Xin-xin;LUO Xiao-xu;HAO Ying-xia(The Second Department of Gastroenterology,the First Central Hospital of Baoding City,Baoding,Hebei 071000,China)

机构地区：[1]保定市第一中心医院消化二科,河北保定071000

出　　处：《临床误诊误治》2022年第2期5-8,15,共5页Clinical Misdiagnosis & Mistherapy

基　　金：保定市科技计划项目(1951ZF049)。

摘　　要：目的探讨自身免疫性胃炎的临床特点及误诊原因,并总结防范误诊措施。方法回顾性分析2018年1月—2021年5月收治的40例被误诊为各类贫血的自身免疫性胃炎临床资料。结果本组误诊率为61.5%。40例均以贫血或全血细胞减少就诊,26例存在胃肠道症状,3例有明显的神经症状,其中1例诊断脊髓亚急性联合变性,2例肌电图诊断周围神经病变,误诊时间1周~40年。33例符合巨幼细胞性贫血(2例同时存在溶血性贫血),7例符合缺铁性贫血。所有患者均行胃镜检查,仅11例诊断慢性萎缩性胃炎,再次回顾所有患者胃镜图像均存在典型局限于胃底、胃体部的黏膜萎缩,胃窦黏膜正常。实验室检查26例总胆红素及间接胆红素升高,31例乳酸脱氢酶和(或)α-羟丁酸脱氢酶升高。32例检测壁细胞抗体、内因子抗体阳性。本组均确诊为自身免疫性胃炎,给予补充维生素B_(12)、叶酸治疗,6例住院期间输血治疗。所有患者均有不同程度贫血好转,胆红素及乳酸脱氢酶、α-羟丁酸脱氢酶明显下降。结论自身免疫性胃炎消化道症状为非特异性消化不良,常以血液系统异常和神经精神症状起病,误诊率高,临床医师应加强对本病的认识,降低误诊率。Objective To explore clinical characteristics and misdiagnosed causes of autoimmune gastritis,and to summarize preventive measures.Methods Clinical data of 40 patients with autoimmune gastritis misdiagnosed as various kinds of anemia admitted between January 2018 and May 2021 was retrospectively analyzed.Results The misdiagnosed rate in this group was 61.5%.All the patients visited doctors for anemia or pancytopenia.Among the 40 patients,26 patients had gastrointestinal symptoms;3 patients had obvious neurological symptoms,in which one patient was diagnosed as having spinal subacute combined degeneration,and two patients were diagnosed as having peripheral neuropathy by electromyogram.Misdiagnosed duration ranged from 1 week to 40 years.Consequently,33 patients were suspected with megaloblastic anemia(2 of them simultaneously had hemolytic anemia),and 7 patients were suspected with iron deficiency anemia.All patients underwent gastroscopy,and only 11 patients were diagnosed as having chronic atrophic gastritis.All patients had tunica mucosa atrophy restricted to typical gastric fundus and body of the stomach and normal tunica mucosa of gastric antrum when the endoscopic images had been retrospectively reviewed.Laboratory examinations showed elevated levels of total bilirubin and indirect bilirubin in 26 patients and elevated levels of lactate dehydrogenase and/orα-hydroxybutyrate dehydrogenase in 31 patients.Of them,32 patients were positive for parietal cell antibodies and internal factor antibodies.All the patients were confirmed as having autoimmune gastritis and treated with vitamin B_(12) and Folic Acid supplementation,and 6 patients were treated with blood transfusion during the hospitalization.Anemia was improved in all patients in different degrees.Meanwhile,levels of bilirubin,lactate dehydrogenase andα-hydroxybutyrate dehydrogenase were significantly decreased.Conclusion The gastrointestinal symptoms of autoimmune gastritis are non-specific dyspepsia.Patients with autoimmune gastritis always seek medi

关 键 词：自身免疫性胃炎 误诊 贫血 巨幼细胞性 贫血 缺铁性 胃黏膜萎缩 

分 类 号：R573.32[医药卫生—消化系统]