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目的 探讨自身免疫性胃炎（AIG）的临床及病理特点。方法 回顾性分析2022年1月至2024年12月通过内镜活检诊断为AIG的39例患者的临床及病理资料。结果 确诊病例23例，疑似病例16例，女性25例，男性14例，发病年龄33～82岁，中位年龄56岁；内镜下主要表现为胃体、底黏膜萎缩，胃窦部基本正常，部分出现黏膜息肉样隆起。组织学显示，胃体、胃底黏膜固有层不同程度慢性炎细胞浸润、固有腺减少伴壁细胞减少、肠上皮化生、（假）幽门腺化生及胰腺腺泡化生；37例见神经内分泌细胞增生性病变/肿瘤：21例神经内分泌细胞增生，2例异型增生，14例神经内分泌瘤（NET）。实验室检查结果显示，27例中有23例检测到抗壁细胞抗体（APCA）阳性和/或内因子抗体（AIFA）阳性，24例中20例血胃泌素升高。患者临床表现无特异性，12例患有贫血，15例合并其他自身免疫性疾病，2例胃腺癌。结论 AIG发病多见于中老年女性，临床表现无特异性，当内镜下发现胃体、底黏膜萎缩性改变，尤其患者合并贫血、其他自身免疫性疾病，要怀疑AIG的诊断，建议常规多点胃黏膜活检，仔细病理检查以及血清抗体监测。
Abstract：Objective To investigate the clinicopathological features of autoimmune gastritis(AIG). Methods The clinical and pathological data of 39 patients with AIG by endoscopic biopsy from January 2022 to December 2024 were retrospectively analyzed. Results Among the 39 patients(23 confirmed cases and 16 suspected cases), 25 were females and 14 were males. The age at onset ranged from 33 to 82 years, with a median age of 56 years. Endoscopically, the main manifestations were mucosal atrophy in the gastric body and fundus, while the gastric antrum was basically normal. Polypoid lesions were found in some patients. Histologically, the lamina propria of the gastric body and fundus showed infiltration of chronic inflammatory cells of varying degrees, a decrease in intrinsic glands accompanied by a reduction in parietal cells, intestinal metaplasia,(pseudo) pyloric gland metaplasia, and pancreatic acinar metaplasia. Neuroendocrine cell proliferative lesions/tumors were found in 37 cases: 21 cases of neuroendocrine cell hyperplasia, 2 cases of dysplasia, and 14 cases of neuroendocrine tumors. Laboratory tests revealed that 23 out of 27 patients were positive for anti-parietal cell antibody(APCA) and/or anti-intrinsic factor antibody(AIFA), and 20 out of 24 patients had elevated serum gastrin levels. The clinical manifestations of patients were non-specific. Among the 39 patients, 12 cases had anemia, 15 cases were complicated with other autoimmune disorders, and 2 cases had gastric adenocarcinoma. Conclusion AIG predominantly affects middle-aged women with non-specific clinical manifestations. When endoscopic examination finds gastric mucosal atrophy in the gastric body and fundus, especially in patients complicated with anemia or other autoimmune disorders, the diagnosis of AIG should be suspected.
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基本信息:
中图分类号:R573.3
引用信息:
[1]袁许亚,李秀清,张逸,等.自身免疫性胃炎39例临床病理特征分析[J].诊断病理学杂志,2025,32(12):1606-1610.
2025-10-29
2025-10-29
2025-10-29