自身免疫性胃炎179例的临床和内镜下表现  

Clinical and endoscopic features of 179 cases of autoimmune gastritis

作　　者：陈治吉 邓超 胥峰 卢俊宇 周智航 吴素华[1] 何松[1] Chen Zhiji;Deng Chao;Xu Feng;Lu Junyu;Zhou Zhihang;Wu Suhua;He Song(Department of Gastroenterology,the Second Affiliated Hospital of Chongqing Medical University,Chongqing 400010,China)

机构地区：[1]重庆医科大学附属第二医院消化内科,重庆400010

出　　处：《中华消化杂志》2023年第8期531-536,共6页Chinese Journal of Digestion

摘　　要：目的探讨自身免疫性胃炎(AIG)患者的临床和内镜下表现特征,提高AIG的临床诊断准确性。方法回顾性分析2020年1月3日至2021年11月25日重庆医科大学附属第二医院诊断的179例AIG患者的一般情况(性别、年龄)、实验室检查指标和内镜下表现。实验室检查指标包括血红蛋白、胃泌素-17、胃蛋白酶原(PG)、贫血组合指标(铁蛋白、维生素B12)、甲状腺功能指标(促甲状腺激素、甲状腺球蛋白抗体、甲状腺过氧化物酶抗体)、幽门螺杆菌,以及抗胃壁细胞抗体和抗内因子抗体。采用描述性方法进行统计学分析。结果179例AIG患者中,年龄为(55.23±12.04)岁,男42例(23.5%),女137例(76.5%)。AIG患者的胃泌素-17为195.31 ng/L(143.64 ng/L,273.61 ng/L),PGⅠ、PGⅠ/PGⅡ比值分別为12.40μg/L(7.65μg/L,19.40μg/L)、1.03(0.66,1.52)。15.3%(18/118)的患者合并缺铁性贫血,16.1%(19/118)的患者合并巨幼红细胞贫血。抗胃壁细胞抗体阳性率为71.8%(51/71),抗内因子抗体阳性率为25.4%(18/71)。27.3%(15/55)的患者血清促甲状腺激素水平升高,甲状腺球蛋白抗体、甲状腺过氧化物酶抗体阳性率分别为31.6%(12/38)、47.4%(18/38)。幽门螺杆菌阳性率为29.7%(38/128)。AIG的内镜下表现提示逆萎缩改变,表现为胃底、胃体黏膜萎缩明显,而胃窦黏膜萎缩不明显。67.0%(120/179)的患者内镜下可见难以冲洗的黄白色浑浊黏液,19.6%(35/179)的患者内镜下可见残存胃底腺。179例AIG患者中共发现7例(3.9%)神经内分泌肿瘤(NET),7例(3.9%)早期胃腺癌(其中低分化腺癌1例),1例(0.6%)腺瘤,14例(7.8%)增生性息肉,除低分化腺癌患者行外科手术外,其余均予以内镜下切除治疗。结论当发现不明原因缺铁性贫血、巨幼红细胞贫血,或内镜下发现逆萎缩时,需考虑AIG。AIG患者为胃癌和NET的高危人群,应对其进行密切随访,并在贫血和神经系统症状出现前给予积极治疗。Objective To explore the clinical and endoscopic features of patients with autoimmune gastritis(AIG)and to improve the accuracy of clinical diagnosis of AIG.Methods From January 3,2020 to November 25,2021,the general information(gender,age),laboratory examination indicators and endoscopic findings of 179 AIG patients diagnosed at the Second Affiliated Hospital of Chongqing Medical University were retrospectively analyzed.The laboratory examination indicators included hemoglobin,gastrin-17,pepsinogen(PG),anemia combination indicators(ferritin,vitamin B12),thyroid function indicators(thyroid-stimulating hormone,thyroglobulin antibody and thyroid peroxidase antibody),Helicobacter pylori,and anti-parietal cell antibody and anti-intrinsic factor antibody.Descriptive methods were used for statistical analysis.Results Among the 179 AIG patients,there were 42 males(23.5%)and 137 females(76.5%),with an average age of(55.23±12.04)years old.The gastrin-17 level of AIG patients was 195.31 ng/L(143.64 ng/L,273.61 ng/L),PGⅠlevel and PGⅠ/PGⅡratio were 12.40μg/L(7.65μg/L,19.40μg/L)and 1.03(0.66,1.52),respectively.There were 15.3%(18/118)of the AIG patients with iron deficiency anemia,and 16.1%(19/118)with megaloblastic anemia.The positive rate of anti-parietal cell antibody was 71.8%(51/71),and the positive rate of anti-intrinsic factor antibody was 25.4%(18/71).The serum thyroid-stimulating hormone level increased in 27.3%(15/55)of the patients,and the positive rates of thyroglobulin antibody and thyroid peroxidase antibody were 31.6%(12/38)and 47.4%(18/38),respectively.The positive rate of Helicobacter pylori was 29.7%(38/128).The endoscopic appearance of AIG indicated reverse atrophy,characterized by obvious atrophy in gastric fundus and gastric body mucosa,however the atrophy of gastric antrum was not obvious.Under endoscopy yellow-white turbid mucus,which was difficult to be washed,was found in 67.0%(120/179)of the patients,and under endoscopy the residual gastric fundus glands could be seen in 19.6%(35/179)of the

关 键 词：自身免疫性胃炎 自身免疫病 贫血 神经内分泌瘤 

分 类 号：R573.3[医药卫生—消化系统]