自身免疫性胃炎161例临床病例分析  

Autoimmune Gastritis:Analysis of 161 Clinical Cases

作　　者：徐洲 叶成 朱林文思 吴湘萍[2] 沈严婕 吕宾[1] XU Zhou;YE Cheng;ZHU Linwensi;WU Xiangping;SHEN Yanjie;LÜBin(Department of Gastroenterology,the First Affiliated Hospital of Zhejiang Chinese Medical University,Hangzhou,310006;Department of Pathology,the First Affiliated Hospital of Zhejiang Chinese Medical University,Hangzhou,310006)

机构地区：[1]浙江中医药大学附属第一医院消化内科,310006 [2]浙江中医药大学附属第一医院病理科,310006

出　　处：《胃肠病学》2024年第8期454-459,共6页Chinese Journal of Gastroenterology

摘　　要：背景:自身免疫性胃炎(AIG)是一种由CD4+T细胞免疫介导的疾病。近年来随着对该病认识的深入,我国AIG病例报道逐渐增多。目的:分析总结AIG的临床特点,提高临床医师对该病的识别能力。方法:收集2018年8月—2023年12月在浙江中医药大学附属第一医院诊断为AIG的患者,分析其临床、实验室、内镜和病理特征。结果:共161例AIG患者纳入研究,男性63例,女性98例,平均年龄56.81岁,多无特异性临床表现。合并自身免疫病主要为桥本甲状腺炎(8.1%)和类风湿关节炎(5.0%)。平均血清胃泌素⁃17、胃蛋白酶原(PG)Ⅰ、维生素B12、血红蛋白水平分别为44.68 pmol/L、38.61μg/L、344.45 pmol/L和133.17(男)/122.79(女)g/L;抗壁细胞抗体阳性率为100%,抗甲状腺球蛋白抗体和抗甲状腺过氧化物酶抗体阳性率分别为46.0%和29.8%。107例患者内镜下呈现胃体、胃底明显萎缩而胃窦无萎缩的“逆萎缩”现象,54例为全胃萎缩,但以胃体、胃底为主。分别有6例、8例和1例患者检出胃神经内分泌瘤(gNET)、早期胃腺癌和印戒细胞癌。90例行病理检查的胃黏膜标本中,24例见淋巴细胞和浆细胞浸润,无明显胃底腺萎缩;42例固有腺体萎缩,淋巴细胞浸润;24例肠嗜铬样细胞增生,形成内分泌微巢。结论:AIG发病更多见于中老年,女性稍多于男性。患者出现低PGⅠ合并高胃泌素血症时需考虑AIG。AIG有较高的gNET和胃腺癌发生风险,患者应接受胃镜监测。Background:Autoimmune gastritis(AIG)is a CD4+T cell⁃mediated immune disease.In recent years,with deepening of the understanding of this entity,reports of AIG cases in China have been gradually increasing.Aims:To analyze and summarize the clinical characteristics of AIG for better disease recognition and diagnosis.Methods:Data on AIG patients diagnosed at the First Affiliated Hospital of Zhejiang Chinese Medical University from August 2018 to December 2023 were collected,and the clinical,laboratory,endoscopic,and pathological characteristics were reviewed and analyzed.Results:A total of 161 AIG patients were included,with the mean age of 56.81 years old,63 were males and 98 were females.Most of the patients exhibited no characteristic clinical symptoms.The main comorbid autoimmune diseases were Hashimoto′s thyroiditis(8.1%)and rheumatoid arthritis(5.0%).Serum levels of the key laboratory measurements were as follows:gastrin⁃17,44.68 pmol/L;pepsinogen(PG)Ⅰ,38.61μg/L;vitamin B12,344.45 pmol/L;hemoglobin,133.17(male)/122.79(female)g/L.The positivity rates of anti⁃parietal cell antibody,anti⁃thyroglobulin antibody and anti⁃thyroid peroxidase antibody were 100.0%,46.0%and 29.8%,respectively.One hundred and seven cases exhibited the"reverse atrophy"phenomenon endoscopically,characterized by significant atrophy of the corpus and fundus and no atrophy in antrum;while 54 cases showed pan⁃gastric atrophy,predominantly in the corpus and fundus.Fifteen cases of gastric neoplastic lesions were detected,including 6 gastric neuroendocrine tumor(gNET),8 early adenocarcinoma and 1 signet⁃ring cell carcinoma.Pathological analysis were performed in 90 cases of gastric mucosal specimens,24 cases exhibited lymphocyte and plasma cell infiltration without significant atrophy of the fundic gland,42 cases presented with glandular atrophy and lymphocyte infiltration,and 24 cases showed enterochromaffin⁃like cell hyperplasia and the formation of endocrine micro⁃nests.Conclusions:AIG is more common in middle⁃aged and

关 键 词：自身免疫性胃炎 高胃泌素血症 内镜检查 胃肿瘤 

分 类 号：R573.3[医药卫生—消化系统]