自身免疫性胃炎的临床特点

摘要

目的 分析自身免疫性胃炎(AIG)的临床特点.方法 回顾性分析1990年1月至2010年4月收治的55例AIG患者的临床资料,实验室检查项目包括Hb、LDH、α-羟丁酸脱氢酶(α-HBDH)、胃泌素、内因子抗体、壁细胞抗体、胃镜及病理活组织检查、24 h胃酸监测等.另选取31例巨幼细胞性贫血患者作为对照.采用独立样本t检验进行统计学处理.结果 55例AIG患者中,49例伴有巨幼细胞性贫血.4例检测内因子抗体的贫血患者中3例阳性.43.8％(21/48)的患者壁细胞抗体阳性.治疗前,伴有贫血的AIG患者的LDH[(1045.50±853.46) U/L]及α-HBDH[(853.71±824.23) U/L]明显升高,与不伴有贫血的AIG患者[(166.67±41.03) U/L,(133.67±27.90) U/L]相比差异均有统计学意义(t=-4.665、-2.120,P均＜0.05),与对照组[(1047.52±1028.31) U/L,(1050.23±1264.37) U/L]相比,差异均无统计学意义(P均＞0.05).共46例行胃镜检查,29例胃体萎缩而胃窦不受累,占63.0％；16例胃窦、胃体均无萎缩,占34.8％,其中7例胃黏膜表现为肠上皮化生,1例表现为肠上皮化生伴不典型增生；1例胃窦、胃体均有萎缩,占2.2％.结论 AIG患者LDH、α-HBDH升高可能与巨幼细胞性贫血导致的骨髓原位溶血有关.建议AIG患者将内因子抗体检测作为常规检查.依靠胃镜活组织病理诊断AIG有一定的局限性,需结合临床特点进行诊断.%Objective To analyze the clinical characteristic of autoimmune gastritis (AIG).Methods From January 1990 to April 2010,the clinical data of 55 AIG patients were retrospectively analyzed,which included hemoglobin,lactate dehydrogenase (LDH),α-hydroxybutyrate dehydrogenase (α-HBDH),gastrin,intrinsic factor antibody (IFA),parietal cell antibody (PCA),gastrointestinal endoscopy examination and 24-hour esophageal pH recording.Another 31 megaloblastic anemia (MA) patients were selected as control.Statistical analysis was performed by independent-samples t test.Results Among 55 AIG patients,49 patients were associated with MA,and three out of four cases were identified of IFA.About 43.8％ (21/48) patients were PCA positive.Before treatment,the levels of LDH and α-HBDH of AIG patients with MA were (1045.50±853.46)U/L and (853.71±824.23) U/L which significantly increased,than those of patients without MA [(166.67±41.03) U/L,(133.67±27.90) U/L],the differences were statistically significant (t=-4.665,-2.120,both P＜0.05),however there was no significant difference when compared with the control group [(1047.52±1028.31) U/L,(1050.23±1264.37) U/L,both P＞0.05)].A total of 46 patients underwent gastroendoscopy examination,63.0％ (29/46) patients had gastric body atrophy while gastric antrum not involved; 34.8％ (16/46) patients had neither gastric body nor antrum atrophy; seven patients gastric mucosal showed intestinal metaplasia and one patient showed intestinal metaplasia with atypical hyperplasia and 2.2％ (1/46) presented both the antrum and the body atrophy.Conclusions The levels of LDH and α-HBDH increased in AIG patients might be related with MA caused marrow in-situ hemolysis.IFA is recommended as a routine test for AIG.There is still some limitations of AIG diagnosis according to histopathological features of gastric endoscopy specimen.The clinical features should be taken into consideration.