自身免疫性胃炎的临床及内镜下表现（附31例报告）

Clinical and endoscopic manifestations of autoimmune gastritis (31 cases)

摘要:

目的 总结自身免疫性胃炎患者的主要临床表现和内镜特点，以期提高临床对自身免疫性胃炎的诊断水平。方法 选择2019年1月－2020年12月柳州市人民医院31例经内镜及血清学确诊的自身免疫性胃炎患者，分析患者的临床表现、胃镜检查、病理检查、合并症、实验室检查和随访结果。结果 31例患者中，纳差14例（45.2%），上腹胀12例（38.7%），缺铁性贫血7例（22.6%），巨幼红细胞贫血5例（16.1%），合并胃神经内分泌肿瘤4例（12.9%），合并脊髓亚联综合征2例（6.5%），合并Ⅰ型糖尿病1例（3.2%），合并自身免疫性甲状腺炎1例（3.2%）。内镜下表现在胃底腺区域高度萎缩，胃窦部没有发现萎缩；部分患者内镜下见黏膜下隆起，病理检查证实为神经内分泌肿瘤。壁细胞阳性28例（90.3%），内因子抗体阳性3例（9.7%），抗胃壁细胞抗体及内因子抗体均阳性6例（19.4%）。13例行胃泌素-17及胃蛋白酶检查，8例（25.8%）出现胃泌素-17升高、胃蛋白酶原Ⅰ/Ⅱ降低。幽门螺旋杆菌抗体测定10例（32.3%）阳性。组织病理以胃体、胃底黏膜慢性炎性病变为主，伴有不同程度的肠上皮化生。合并神经内分泌肿瘤者经氩气刀及内镜下黏膜切除术治疗，目前仍在随访，合并脊髓亚联综合征患者补充维生素B₁₂后神经系统症状改善，巨幼红细胞贫血及缺铁性贫血患者分别补充维生素及二价铁后，血红蛋白较前上升。结论 自身免疫性胃炎起病隐匿，巨幼红细胞贫血或慢性缺铁性贫血口服补铁效果欠佳者，要考虑是否合并自身免疫性胃炎；内镜检查发现逆向萎缩表现时，需完善抗胃壁细胞抗体、内因子抗体检查和胃黏膜组织活检，以排除自身免疫性胃炎。

Abstract:

Objective To summarize the main clinical manifestations and endoscopic features of patients with autoimmune gastritis, and improve the clinical diagnosis level of autoimmune gastritis.Methods We collected 31 cases of autoimmune gastritis confirmed by endoscopy and serology from January 2019 to December 2020, then analyze their clinical manifestations, gastroscopy, pathological examination, complications, laboratory examination and results of followed up.Results In the 31 cases of autoimmune gastritis, there were 14 cases (45.2%) of anorexia, 12 cases (38.7%) of upper abdominal distension, 7 cases (22.6%) of iron deficiency anemia, 5 cases (16.1%) of mega-loblastic anemia, 4 cases (12.9%) of gastric neuroendocrine tumor, 2 cases (6.5%) of subacute spinal cord syndrome, 1 case (3.2%) of type 1 diabetes mellitus and 1 case (3.2%) of autoimmune thyroiditis; Endoscopy showed that the area of gastric fundus gland was highly atrophic, and no atrophy was found in the antrum. In some patients, submucosal eminence was found under endoscopy, and neuroendocrine tumor was confirmed by biopsy and pathology; parietal cells were positive in 28 cases (90.3%), internal factor antibody in 3 cases (9.7%), anti-parietal cell antibody and internal factor antibody in 6 cases (19.4%). 13 patients were examined for gastrin-17 and pepsin, 8 patients (25.8%) had increased gastrin-17, pepsinogen I/Ⅱ was decreased. Helicobacter pylori antibody test was positive in 10 cases (32.3%); Chronic inflammatory lesions of gastric body and gastric fundus mucosa were the main pathological changes, accompanied by varying degrees of intestinal metaplasia; The patients with neuroendocrine tumor were treated with argon knife and endoscopic mucosal resection, they are still being followed up, neurological symptoms improved after vitamin B₁₂ supplementation in patients with associated spinal cord syndrome, the hemoglobin of mega-loblastic anemia and iron deficiency anemia patients increased after vitamin and iron supplementation respectively.Conclusion Autoimmune gastritis insidious onset, mega-loblastic anemia or chronic iron deficiency anemia oral supplementation effect is not good, should be vigilant against the possibility of autoimmune gastritis; When the reverse atrophy was found by endoscopy, anti-parietal cell antibody, internal factor antibody and gastric mucosa biopsy should be improved to rule out autoimmune gastritis.