自身免疫性萎缩性胃炎的诊断延误与应对策略

Delayed diagnosis of autoimmune atrophic gastritis and its coping strategies

既往认为自身免疫性萎缩性胃炎(AAG)是罕见病,随着内镜检查的广泛开展,发现AAG并不少见,且与胃腺癌、胃神经内分泌肿瘤的高发有关。然而,AAG的诊断主要依赖自身抗体、内镜和组织学检查结果,缺乏特征性的临床表现,常在患者发生恶性贫血或出现神经症状时才考虑AAG的筛查与诊断,导致AAG诊断的延误。文章总结了近年来AAG的研究进展,分析AAG诊断延误的原因,并提出应对策略。

Autoimmune atrophic gastritis(AAG)is a slowly progressive,immune‐mediated disorder with unspecific and subtle clinical manifestations.With the widespread use of endoscopy,especially the progression of early gastric cancer screening,it has increased awareness that AAG is a pre‐neoplastic condition,predisposing to the development of both type 1 neuroendocrine tumors and gastric adenocarcinoma.The diagnosis of AAG is based on distinctive endoscopic and histological features and serum intrinsic factor and/or parietal cell autoantibody positivity,which is challenging due to its wide clinical spectrum-ranging from a symptomless to a disabling disease course.This article summarizes the research progress of AAG in recent years,analyzes the reasons for delayed diagnosis of AAG,and proposes coping strategies.