上海地区对慢性萎缩性胃炎的研究

A REPORT ON RECENT STUDIES OF CHRONIC ATROPHIC GASTRITIS IN SHANGHAI

本文综合上海地区部分医疗单位对慢性萎缩性胃炎(CAG)的一些研究资料,包括病因学调查,光学和电子显微镜的病理学观察,泌酸功能的研究,血清胃泌素的测定,以及免疫学方面的一些研究等。调查提示吸烟、饮食不规则、胆汁返流等因素可能和CAG的发生有关。指出壁细胞泌酸功能与胃窦的萎缩性变化及肠腺化生程度有关,而按胃酸分泌功能和试餐后血清胃泌素值变化来分型,更能准确反映胃窦和胃体的病理生理。以酶免疫法测定壁细胞抗体(PCA)的阳性率高于免疫荧光法.因PCA测定有假阳性,故认为其仅示有胃粘膜的损害,而对CAG的诊断并无特异性.本文提出,CAG可分为A、B和B诸型,在我国华东地区以B型为多见.观察发现,我国的A型患者临床上很少出现恶性贫血.

This report summarized the results of studies on chronic atrophic gastritis(CAG)fromseveral hospitals in Shanghai,which included a survey of etiological factors,histopathologicand ultrastructural studies of gastric mucosa,gastric acid secretory test,fasting serumgastrin determination and augmented protein-meal stimulated gastrin secretion test,andcertain immunological determinations.It was found that acid secretory function correlatedwell with the severity of antral atrophic lesion and intestinal metaplasia.However,theclassification of CAG could be made according to the acid secretory function test and thedynamic serum gastrin response pattern to a test meal which reflect more correctly thepathophysiological lesion at gastric body and antrum.The enzyme linked immunnassay(ELISA)was more sensitive than immunofluorescent assay(IF)for detection of theparietal cell antibody(PCA).As false-positive test of PCA was frequently found inpatients without CAG,so a positive PCA might only indicate existence of gastric mucosallesion.It was suggested that CAG could be separated into two types,A and B,the latter beingfurther divided into subtypes Band B.The prevalence of B type CAG was higher ineast China,and pernicious anemia was rare in patients with A type CAG.