慢性萎缩性胃炎与巨幼细胞贫血的相关性

目的探讨慢性萎缩性胃炎与巨幼细胞贫血发生的相关性,同时观察幽门螺杆菌（Hp）感染对巨幼细胞贫血发生的影响。方法检测117例慢性胃炎（包括萎缩性与非萎缩性）患者（其中不伴巨幼细胞贫血者55例,伴巨幼细胞贫血者62例）血清胃蛋白酶原（pepsinogen,PG）Ⅰ、PGⅡ、维生素B₁₂及叶酸水平。Hp经¹³C呼气试验及快速尿素酶法检测。结果慢性萎缩性胃炎伴巨幼细胞贫血组血清PGⅠ、PGⅡ、PGⅠ/PGⅡ水平明显低于非贫血组（P<0.05）,尤其以胃窦胃体萎缩为著（P<0.05）。伴巨幼细胞贫血组中,萎缩性胃炎组血清维生素B₁₂及叶酸水平均低于非萎缩性胃炎组（P<0.05）;胃窦胃体萎缩组中血清维生素B₁₂水平低于胃窦萎缩组（P<0.05）。在萎缩性胃炎与非萎缩性胃炎中,Hp阳性组血清维生素B₁₂水平较Hp阴性组均明显降低（P<0.05）。结论慢性萎缩性胃炎与巨幼细胞贫血可能相互作用、互为因果;Hp感染可促进萎缩性胃炎的发生,同时会影响维生素B₁₂及叶酸的吸收,间接导致巨幼细胞贫血的发生。

Relationship between chronic atrophic gastritis and megaloblastic anemia

Objective To investigate the relationship between chronic atrophic gastritis and megaloblastic anemia,and to explore the effect of Hp infection on megaloblastic anemia.Methods A total of 117 patients with chronic gastritis diagnosed by gastroendoscopy were obtained,including 62 patients with megaloblastic anemia and 55 patients without megaloblastic anemia.Hp status was determined by ¹³C-urea breath test and urea enzymes test.Serum pepsinogen（PG）Ⅰand PGⅡwere detected by immunoturbidimetric assay.Vitamin B₁₂and folic acid levels were detected by electrochemiluminescence method.Results In chronic atrophic gastritis,PGⅠ,PGⅡand PGⅠ/PGⅡwere decreased in patients with megaloblastic anemia compared with the patients without megaloblastic anemia（P< 0.05）.PGⅠlevel,PGⅠ/PGⅡin antral and body atrophic gastritis with megaloblastic anemia were decreased compared with that without anemia（P<0.05）.For patients with megaloblastic anemia,vitamin B₁₂and foliate levels were decreased in patients with atrophic gastritis compared with patients with non-atrophic gastritis（P<0.05）.Vitamin B₁₂levels were decreased in antral and body atrophic gastritis compared with antral atrophic gastritis（P<0.05）.In non-atrophic gastritis group,vitamin B₁₂levels were decreased in Hp-positive group compared with Hp-negative group（P<0.05）.Conclusion Chronic atrophic gastritis and megaloblastic anemia may interact and reinforce each other.Hp infection can not only aggravate the occurrence of atrophic gastritis but also affect the absorption of vitamin B₁₂and folic acid,which may bring about the occurrence of megaloblastic anemia indirectly.