自身免疫性胃炎临床特征分析:单中心回顾性研究  

Analysis of Clinical Characteristics of Autoimmune Gastritis:Single Center Retrospective Study

作　　者：刘敏 肖伟 张彩凤[1] LIU Min;XIAO Wei;ZHANG Caifeng(Department of Gastroenterology,the First Affiliated Hospital of Xinxiang Medical University,Xinxiang 453100,China;Department of Gastroenterology,Yellow River Central Hospital,Zhengzhou 450003,China;Department of Gastroenterology,Henan Provincial People’s Hospital,Zhengzhou 450003,China)

机构地区：[1]新乡医学院第一附属医院消化内科,河南新乡453100 [2]黄河中心医院消化内科,河南郑州450003 [3]河南省人民医院消化内科,河南郑州450003

出　　处：《河南医学研究》2025年第7期1167-1173,共7页Henan Medical Research

摘　　要：目的统计分析自身免疫性胃炎(AIG)的临床、内镜及病理特征,提高临床对AIG的认识和诊疗水平。方法收集2018年1月至2023年5月就诊于河南省人民医院的149例AIG患者的病历资料,具体包括确诊年龄、性别、临床症状、血清学检查、幽门螺杆菌(Hp)检测、合并症、胃镜检查及病理结果等,将收集结果进行分析、归纳、总结。结果149例患者中,确诊年龄29~81岁,平均(58.50±11.88)岁,女性多于男性(96例比53例)。常见临床症状为消化不良[82例(55.0%)]、贫血[缺铁性贫血46例(30.9%)、巨幼细胞贫血20例(13.4%)]、脊髓亚急性联合变性[5例(3.4%)],部分患者无症状。149例患者中抗壁细胞抗体(PCA)阳性131例(87.9%)、抗内因子抗体阳性(IFA)44例(29.5%),两者均阳性29例(19.5%),两者均阴性2例(1.3%)。本研究所纳入患者采用ELISA法行胃功能检查,胃泌素-17(G-17)(55.64±29.27)pmol·L^(-1);胃蛋白酶原Ⅰ(PGⅠ)(52.84±18.42)μg·L^(-1),胃蛋白酶原Ⅰ/Ⅱ(PGR)6.14±3.63。其中117例患者行Hp检测,阴性者占多数[阴性74例(49.7%)比阳性43例(28.9%)比不明32例(21.5%)]。AIG常合并其他自身免疫性疾病,其中自身免疫性甲状腺炎18例(12.1%)、自身免疫性肝炎4例(2.7%)、类风湿关节炎4例(2.7%)、干燥综合征1例(0.7%)、强直性脊柱炎1例(0.7%)、1型糖尿病1例(0.7%)。结合内镜及病理表现,合并胃息肉59例(39.6%)、胃癌6例(4.0%)、Ⅰ型胃神经内分泌肿瘤(g-NET)38例(25.5%),病理见肠上皮化生47例(31.5%)、内分泌细胞微巢(ECM)16例(10.7%)。进一步分析明确AIG患者发生Ⅰ型g-NET的危险因素,单因素分析显示发生Ⅰ型g-NET的AIG患者确诊年龄更小[(54.42±10.83)岁比(59.89±11.95)岁]、G-17水平更高[62.37(46.31,86.01)pmol·L^(-1)比48.91(39.72,59.37)pmol·L^(-1)]、合并ECM占比更高[39.5%(15/38)比0.9%(1/111)],差异有统计学意义(P<0.05);多因素logistic回归分析显示G-17(OR=1.020,95%CI:1.005~1.035)、ECM(OR=59.163,95%CI:7.250~482Objective To statistically analyze the clinica,endoscopic and pathological characteristics of autoimmune gastritis(AIG),and to improve clinical understanding and diagnosis and treatment level of AIG.Methods Data of 149 AIG patients who visited Henan Provincial People’s Hospital from January 2018 to May 2023 were collected,including confirmed age,gender,clinical symptoms,serological tests,Helicobacter pylori(Hp)detection,comorbidities,gastroscopy,and pathological results.The collected results were analyzed and summarized.Results Among 149 patients,the age of diagnosis was 29-81 years old,the average age was(58.50±11.88)years old,and the female was more than the male(96 cases vs 53 cases).The common clinical symptoms were dyspepsia[82 cases(55.0%)],anemia[iron-deficiency anemia 46 cases(30.9%),megaloblastic anemia 20 cases(13.4%)],subacute combined degeneration of spinal cord[5 cases(3.4%)],and some patients were asymptomatic.Among 149 patients,131(87.9%)were positive for anti parietal cell antibodies(PCA)and 44(29.5%)were positive for anti-intrinsic factor antibodies(IFA).Both were positive in 29(19.5%)and negative in 2(1.3%).The patients included in this study were tested for gastric function by ELISA.Gastrin-17(G-17)was(55.64±29.27)pmol·L^(-1),pepsinⅠ(PGⅠ)was(52.84±18.42)μg·L^(-1),and ratio of PGⅠto PGⅡ(PGR)was 6.14±3.63.Among them,117 patients underwent Hp testing,with the majority being negative[74 cases negative(49.7%)vs 43 cases positive(28.9%)vs 32 cases unknown(21.5%)].AIG was often associated with other autoimmune diseases,including 18 cases of autoimmune thyroiditis(12.1%),4 cases of autoimmune hepatitis(2.7%),4 cases of rheumatoid arthritis(2.7%),1 case of Sjogren’s syndrome(0.7%),1 case of ankylosing spondylitis(0.7%),and 1 case of typeⅠdiabetes(0.7%).Combined with endoscopic and pathological findings,59 cases(39.6%)of gastric polyps,6 cases(4.0%)of gastric cancer,38 cases(25.5%)of typeⅠgastric neuroendocrine tumor(g-NET),47 cases(31.5%)of intestinal metaplasia and 16 cases(10.7%

关 键 词：自身免疫性胃炎 临床症状 内镜表现 病理特征 合并症 

分 类 号：R573.3[医药卫生—消化系统]