慢性萎缩性胃炎的临床病理学特点分析

目的探讨慢性萎缩性胃炎(CAG)的病理组织学形态、胃镜下表现与血清学检测特征,以提高诊断准确率。方法对65例CAG和135例慢性非萎缩性胃炎(CNAC)的临床病理资料、血清学检测和幽门螺杆菌(Hp)感染情况予以回顾性分析,并结合相关文献进行讨论。结果 CAG临床主要表现为上腹部饱胀、不适或疼痛,餐后明显,同时伴有其他消化不良症状,持续数天或数月不等。胃镜直视下特征表现为胃黏膜变薄,皱襞变浅或消失,色苍白而平滑,透过变薄的黏膜可见黏膜下小血管;长期严重的病例,还可见胃黏膜(多在幽门部)呈细颗粒状,甚至形成息肉。组织学特点比较复杂,其特征性所见是胃黏膜固有腺体(主要是胃窦的幽门腺和胃体的胃底腺)萎缩、以致消失,上皮再生、增生与化生,炎症细胞的浸润和淋巴小结形成,黏膜肌层增生等。血清学检测显示血清胃蛋白酶原(PG)-I及胃泌素-17(G-17)均明显低于CNAC患者,72.3%的CAG患者中Hp阳性伴血清胃蛋白酶原PG-I/PG-II比值(PGR)明显降低。结论 CAG是临床常见的胃癌癌前状态,尤其是伴有肠上皮化生和(或)异型增生则为重要的癌前病变;对其确诊主要依靠胃镜活检组织病理学检查,联合检测血清PG和G-17水平可用于大规模人群的普查,以及对患者的随访和预后监测。

Analysis of the clinicopathological features of chronic atrophic gastritis

Objective To study the histopathology, endoscopic appearance and serological characteristics of chronic atrophic gastritis （CAG） in order to improve the diagnostic accuracy. Methods Retrospective study of the data of 65 CAG patients was conducted to analyze the clinical manifestations, pathological features, serological findings and Helicobacter pylori （Hp） infection in CAG. Results The main clinical manifestations were meal - related abdominal fullness, discomfort or pain, accompanied with other dyspeptic symptoms （ such as belching, acid reflux, nausea, vomiting, weak appetite, etc. ） for a few days or months. Endoscopic findings were characterized by pale and thinning mucosa （ submucosal small blood vessels were visible through the thinning mucosa） and lighter or disappeared folds; in long -term severe cases, fine granular mucosa, and even the formation of polyps could be seen in gastric mucosa （ mainly in the pylorus ）. Histopathological features included atrophy or disappearance of gastric mucosa glands （ mainly antral pyloric glands and fundic glands of gastric body）, epithelial regeneration, hyperplasia and metaplasiat and the infiltration of inflammatory cells, formation of lymphoid nodules, and muscularis mucosa hyperplasia. Serological testing showed serum PG - I and G - 17 were significantly reduced, Hp positive combined with decreased PGR （ PG - I/PG - II ratio） was found in 72% of CAG patients. Conclusion CAG is a common clinical precancerous state, especially accompanied by intestinal metaplasia, and （or） dysplasia. The diagnosis of CAG relies mainly on the histopathological examination of endoscopic biopsy. The joint detection of serum PG and G - 17 levels can be used for the screening of large - scale population, and follow -up and prognosis of CAG patients.