自身免疫性胃炎合并结直肠息肉患者的临床特征分析  

Clinical Characteristics of Autoimmune Gastritis Patients Complicated With Colorectal Polyps

作　　者：金敬争 梁晓[1] 黎钊 宋一鸣 李晓波[1] JIN Jingzheng;LIANG Xiao;LI Zhao;SONG Yiming;LI Xiaobo(Division of Gastroenterology and Hepatology,Renji Hospital,School of Medicine,Shanghai Jiao Tong University,Shanghai Institute of Digestive Disease,Shanghai,200001)

机构地区：[1]上海交通大学医学院附属仁济医院消化内科,上海市消化疾病研究所,200001

出　　处：《胃肠病学》2024年第7期391-395,共5页Chinese Journal of Gastroenterology

摘　　要：背景:已有研究报道了萎缩性胃炎与结直肠息肉之间的相关性。自身免疫性胃炎(AIG)导致壁细胞破坏、胃酸分泌减少和胃黏膜萎缩,可能增加结直肠息肉发生风险。然而,目前关于AIG与结直肠息肉的研究尚少。目的:分析AIG合并结直肠息肉患者的临床特征。方法:回顾性纳入2019年6月—2023年7月就诊于上海交通大学医学院附属仁济医院的AIG合并结直肠息肉患者,收集并分析其病历资料,包括诊断年龄、性别、贫血情况、抗壁细胞抗体(PCA)、抗内因子抗体(IFA)、胃蛋白酶原(PGs)、胃泌素17、维生素B12以及检出息肉的病理特征等。结果:共77例AIG合并结直肠息肉患者纳入研究,女性居多(66.2%),中位诊断年龄63岁,PCA阳性率为84.4%。结直肠息肉最常见的病理类型为腺瘤性息肉(46.3%),其次为增生性息肉(29.9%),好发于乙状结肠(29.9%)、横结肠(20.9%)和升结肠(19.4%)。33例(42.9%)患者同时合并胃息肉,主要为胃体、胃底增生性息肉。合并胃息肉患者的PCA阳性率、血清PGⅡ和胃泌素17水平显著高于无胃息肉者(P均<0.05)。结论:AIG患者最易发生的结直肠息肉为腺瘤性和增生性息肉,好发部位依次为乙状结肠、横结肠和升结肠,约40%的患者同时合并胃息肉。在AIG胃黏膜萎缩背景下,胃息肉与结直肠息肉可能存在共生关系。Background:The association between atrophic gastritis and colorectal polyps has been reported.Autoimmune gastritis(AIG)leads to parietal cell destruction,reduced gastric acid secretion and gastric mucosal atrophy,which may increase the risk of colorectal polyps.However,there are few studies on AIG and colorectal polyps.Aims:To analyze the clinical characteristics of AIG patients complicated with colorectal polyps.Methods:AIG patients complicated with colorectal polyps admitted to Renji Hospital,School of Medicine,Shanghai Jiao Tong University from June 2019 to July 2023 were retrospectively recruited.The medical history was reviewed,data on age at diagnosis,gender,anemia,anti-parietal cell antibody(PCA),anti-intrinsic factor antibody(IFA),pepsinogens(PGs),gastrin-17,vitamin B12,and the presence and pathological features of polyps were collected and analyzed.Results:Seventy-seven cases of AIG patients complicated with colorectal polyps,predominantly females(66.2%),were enrolled.The median age at diagnosis was 63 years old.The positivity rate for PCA was 84.4%.The most common pathological type of colorectal polyps was adenomatous polyps(46.3%),followed by hyperplastic polyps(29.9%).The most common location of colorectal polyps was sigmoid colon(29.9%),followed by transverse colon(20.9%)and ascending colon(19.4%).Thirty-three patients(42.9%)also complicated with gastric polyps,mainly the hyperplastic polyps located at corpus and fundus.Patients with gastric polyps presented higher positivity rate for PCA and higher serum PGⅡand gastrin-17 levels as compared with those without gastric polyps(all P<0.05).Conclusions:The most common pathological types of colorectal polyps in AIG patients are adenomatous and hyperplastic polyps,and the most common sites are sigmoid colon,transverse colon and ascending colon.Nearly 40%of the patients complicated with gastric polyps simultaneously,which suggests that gastric polyps and colorectal polyps might have a symbiotic relationship under the background of gastric mucosal atrophy

关 键 词：自身免疫性胃炎 结直肠息肉 胃息肉 胃泌素17 

分 类 号：R73[医药卫生—肿瘤]