自身免疫性胃炎关联疾病3例报道并文献复习

doi:10.16150/j.1671-2870.2021.05.009

摘要/Abstract

摘要：

目的：分析自身免疫性胃炎关联性疾病病例的临床特点,结合文献进行分析总结,以期指导临床实践。 方法：回顾性分析经内镜检查及血清学检测确诊的3例分别因胃肠道症状伴贫血、胃神经内分泌肿瘤、肝功能异常就诊的合并自身免疫性胃炎患者,总结自身免疫性胃炎与所伴随疾病间的相关性。 结果：病例1以“恶心伴间歇性呕吐伴贫血1个月”,入院后血清学检查提示巨幼红细胞性贫血,胃镜检查提示胃体增生,并在胃镜下对其病灶进行切除治疗,术后病理提示为局部高级别瘤变管状腺瘤;病例2以“反复中上腹部不适数月”就诊,入院后行胃镜检查提示胃体增生,在胃镜下对其病灶进行切除,术后病理提示为神经内分泌肿瘤（G1期）;病例3以“肝功能异常”就诊,肝穿刺活检明确诊断原发性胆汁性胆管炎。3例患者均行胃镜检查后见胃底胃体黏膜层菲薄,黏膜下血管透见,在胃镜下对胃体增生病灶进行活检,病理提示为慢性萎缩性胃炎,且其血清检测内因子抗体和壁细胞抗体均显示阳性,故诊断为自身免疫性胃炎。综合分析相关文献显示,自身免疫性胃炎与巨幼细胞性贫血、神经内分泌肿瘤、原发性胆汁性胆管炎等疾病的发生、发展相关。 结论：本文报道3例分别以巨幼细胞性贫血、胃神经内分泌肿瘤、肝功能异常就诊的病例,就诊中结合其内镜下（表现胃体黏膜萎缩）和血清学标志物检测结果（内因子抗体和壁细胞抗体阳性）,诊断为自身免疫性胃炎,从而为疾病的后续诊治提供依据,故临床医师需注重慢性胃炎与之相关联性疾病的筛查,反之亦然,从而避免疾病的漏诊。

关键词: 自身免疫性胃炎, 关联性疾病, 诊断

Abstract:

Objective: To analyze the clinical characteristics of autoimmune gastritis associated diseases, and review the related literatures so as to provide reference for clinical practice. Methods: Three cases of autoimmune gastritis were diagnosed by endoscopy and serological examination due to gastrointestinal symptoms accompanied with anemia, gastric neuroendocrine tumor or abnormal index of liver function respectively, and the correlation between autoimmune gastritis and associated diseases was explore. Results: Case 1 presented with " nausea accompanied by intermittent vomiting and anemia for 1 month", and serological examination indicated megaloblastic anemia postoperative pathology of gastric hyperplasia lesions showed local high-grade neoplasia tubular adenoma after admission. Case 2 presented with "repeated middle and upper abdominal discomfort for several months". Postoperative pathology of gastric hyperplasia lesions was neuroendocrine tumor (G1 stage) after admission to hospital. Case 3 presented with "abnormal index of liver function", and liver biopsy confirmed the diagnosis of primary biliary cholangitis after admission to hospital. Due to the thin mucosal layer of fundus and submucosal vessel penetration of gastric mucosa atrophy, chronic atrophic gastritis was observed in gastric pathology in all patients. Therefore, all serum tests showed positive results for endogenous factor antibody and parietal cell antibody, and all patients were diagnosed as autoimmune gastritis. Subsequent literature analysis suggested that autoimmune gastritis was associated with the development and progression of megaloblastic anemia, neuroendocrine tumor, primary biliary cholangitis and so on. Conclusions: Three cases reported were treated as megaloblastic anemia or gastric neuroendocrine tumor or abnormal index of liver function on first visit, and subsequently were diagnosed as having autoimmune gastritis. Attention should be paid to autoimmune gastritis associated diseases.

Key words: Autoimmune Gastritis, Associated diseases, Diagnosis

中图分类号:

R573

谭英斌, 谢玲, 吴云林, 陈平. 自身免疫性胃炎关联疾病3例报道并文献复习[J]. 诊断学理论与实践, 2021, 20(05): 484-490.

TAN Yingbing, XIE Lin, WU Yunling, CHEN Ping. Autoimmune gastritis associated diseases: report of 3 cases and literature review[J]. Journal of Diagnostics Concepts & Practice, 2021, 20(05): 484-490.

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