基于内镜筛查发现的自身免疫性胃炎的临床特征分析  

Analysis of clinical characteristics of autoimmune gastritis detected by endoscopic screening

作　　者：刘昌恩 李岩[1] 张其德 Liu Changen;Li Yan;Zhang Qide(Department of Gastroenterology,Hepatobiliary Disease Research Institute,Tianjin Third Central Hospital Affiliated to Nankai University,Tianjin Key Laboratory of In Vitro Life Support for Severe Diseases,Tianjin 300170,China;Digestive Endoscopy Center,Affiliated Hospital of Nanjing University of Chinese Medicine(Jiangsu Province Hospital of Chinese Medicine),Nanjing 210029,China)

机构地区：[1]天津市第三中心医院,天津市重症疾病体外生命支持重点实验室,天津市人工细胞工程技术研究中心,天津市肝胆疾病研究所,天津300170 [2]南京中医药大学附属医院(江苏省中医院)消化内镜中心,南京210029

出　　处：《中华胃肠内镜电子杂志》2024年第4期233-237,共5页Chinese Journal of Gastrointestinal Endoscopy(Electronic Edition)

基　　金：天津市医学重点学科(专科)建设项目(TJYXZDXK-034A)

摘　　要：目的自身免疫性胃炎(AIG)是一种被低估的少见病,本研究旨在总结门诊筛查所见疑似AIG并最终确诊的患者临床特征,并对患者进行分层管理,以实现个体化随访,避免远期出现较重并发症,影响生活质量。方法回顾性分析2023年6月至2023年12月天津市第三中心医院内镜中心经内镜诊断的AIG患者的临床资料。收集患者的基本信息;实验室检查:血常规、抗壁细胞抗体(PCA)、抗内因子抗体(IFA)、甲状腺功能、胃泌素Ⅰ/Ⅱ、G17、叶酸、VitB12等指标。符合正态分布的计量资料两组间比较采用t检验;计数资料两组间比较采用Fisher确切概率法。结果基于内镜筛查并确诊AIG患者12例,男1例、女11例,平均年龄(66.08±12.92)岁。伴发有增生性息肉患者3例(25%)、神经内分泌肿瘤患者2例(16.7%)、早期胃癌患者1例(8.3%)。7例患者出现贫血,血红蛋白(Hb)平均值为(106.08±30.85)g/L,其中IFA阳性的患者的Hb的平均值显著低于IFA阴性的患者。7例患者完善了甲状腺功能检测,促甲状腺激素异常升高3例(42.9%)、甲状腺过氧化物酶抗体阳性6例(85.7%)、甲状腺球蛋白抗体阳性5例(71.4%);胃功能检测9例,其中9例患者G17与PGI明显异常,2例(22.2%)出现PGII异常。结论通过胃镜联合血清学确诊的AIG患者中IFA阳性组的更容易发生恶性贫血及相关胃内并发症,应该更加予以关注并随访管理。Objective Autoimmunegastritis(AIG)isanunderdiagnosed and rare disease.This study aims to summarize the clinical characteristics of patients suspected of AIG through outpatient screening and eventually diagnosed,as well as to stratify patient management to enable personalized follow-up and prevent long-term severe complications that may affect quality of life.Methods A retrospective analysis was performed on the clinical data of AIG patients diagnosed via endoscopy at the Endoscopy Center of Tianjin Third Central Hospital between June 2023 and December 2023.Basic information such as gender,reason for consultation,clinical manifestations,and family history were collected,along with laboratory tests including complete blood count,anti-parietal cell antibodies(PCA),anti-intrinsic factor antibodies(IFA),thyroid function,gastrinⅠ/Ⅱ,G17,folic acid,and vitamin B12 levels.The t-test was used to compare normally distributed quantitative data between two groups,and Fisher's exact test was used for the comparison of categorical data.Results A total of 12 patients were diagnosed with AIG through endoscopic screening,with a male-to-female ratio of 1∶11 and an average age of 66.08±12.92 years.Three patients(25%)had associated hyperplastic polyps,two patients(16.7%)had neuroendocrine tumors,and one patient(8.3%)had early-stage gastric cancer.Seven patients presented with anemia,with an average hemoglobin(Hb)level of(106.08±30.85)g/L.The average Hb level in IFA-positive patients was significantly lower than in IFA-negative patients.Thyroid function tests were completed in seven patients,with three cases(42.9%)showing elevated thyroid-stimulating hormone(TSH),six cases(85.7%)positive for thyroid peroxidase antibodies,and five cases(71.4%)positive for thyroglobulin antibodies.Gastric function tests were completed in nine patients,with abnormal G17 and PGI levels in all cases,and two cases(22.2%)showing abnormal PGII levels.Conclusion Among AIG patients diagnosed through combined endoscopy and serology,those in the IFA-

关 键 词：自身免疫性胃炎 临床特征 恶性贫血 实验室检查 

分 类 号：R573.3[医药卫生—消化系统]