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、I．DH、n羟丁酸脱氢酶（aHBDH）、胃泌素、内因子抗体、壁细胞抗体、胃镜及病理活组织检查、24h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“HBDH[（853．71±824．23）U／L]明显升高，与不伴有贫血的AIG患者[（166．67土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A1G患者LDH、a—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 ）, a hydroxybutyrate dehydrogenase （a-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 a-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 a-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.
出处
《中华消化杂志》
CAS
CSCD
北大核心
2013年第1期28-32,共5页
Chinese Journal of Digestion
关键词
自身免疫疾病
胃炎
L-乳酸脱氢酶
羟丁酸脱氢酶
抗体
内因素
Autoimmune diseases
Gastritis
L-lactate dehydrogenase
Hydroxybutyrate dehydrogenase
Antibodies
Intrinsic factor
