胶原性胃炎的临床特征分析

Clinical Features of Collagenous Gastritis

目的分析胶原性胃炎(CG)的临床特征,为CG精准诊治提供依据。方法通过PubMed、中国知网及万方医学数据库以胶原性胃炎、胶原性胃十二指肠炎、胶原性胃肠道疾病、胃黏膜结节为关键词收集已发表的病例报道及病例系列,整理各病例的人口统计学特征及临床信息。结果共94例CG患者纳入分析,所有患者根据消化道胶原沉积范围分为上消化道胶原沉积性胃炎(UDT-CG)组、全消化道胶原沉积性胃炎(TDT-CG)组及其他组。人口统计学特征:UDT-CG组患者52例,其中女性57.69%、男性42.31%,中位年龄14.50(11.00,25.75)岁;TDT-CG组患者17例,其中女性70.59%、男性29.41%,中位年龄15.00(9.50,48.50)岁;其他组患者25例,其中女性64.00%、男性36.00%,中位年龄25.00(15.50,59.50)岁。临床表现:UDT-CG组患者贫血59.62%、腹泻17.31%,TDT-CG组患者贫血29.41%、腹泻94.12%。胃黏膜结节样表现:UDT-CG组患者75.00%,TDT-CG组患者35.29%。初始治疗:UDT-CG患者对症治疗75.00%(30/40)缓解,激素治疗100%(3/3)缓解;TDT-CG患者对症治疗57.14%(4/7)缓解,激素治疗83.33%(5/6)缓解。复治:UDT-CG患者对症治疗100.00%(3/3)缓解,激素治疗88.89%(8/9)缓解;TDT-CG患者对症治疗80.00%(4/5)缓解,激素治疗66.67%(2/3)缓解。结论CG是一种罕见的胃部胶原沉积疾病,好发于青年患者,女性较男性更易感。临床表现无特异性,贫血、腹痛、腹泻、体重减轻及消化道出血是CG的常见症状,确诊主要依据病理学。胃黏膜结节样外观是CG相对特异性的内镜特征。CG尚无标准化的治疗方案,以对症治疗、改善患者的生活质量为主,必要时可加用激素。

Objective To analyze the clinical characteristics of collagenous gastritis(CG)and provide evidence for the precise diagnosis and treatment of CG.Methods Published case reports and case series were collected from PubMed,CNKI,and Wanfang Med Online with the key words of collagenous gastritis,collagenous gastroduodenitis,collagenous gastrointestinal diseases,and gastric mucosal nodules.The demographic and clinical information of each case was collected.Results According to the extent of collagen deposition in the digestive tract,94 CG cases included in this study were assigned into upper digestive tract(UDT)-CG,total digestive tract(TDT)-CG and other groups.The UDT-CG group included 52 cases(57.69%females and 42.31%males)with a median age of 14.50(11.00,25.75)years old.There were 17 cases in the TDT-CG group,including 70.59%females and 29.41%males,with a median age of 15.00(9.50,48.50)years old.The other group contained 25 cases,(64.00%females and 36.00%males)with a median age of 25.00(15.50,59.50)years old.The main clinical manifestations in the UDT-CG group were anemia(59.62%)and diarrhea(17.31%),and those in the TDT-CG group were anemia(29.41%)and diarrhea(94.12%).The nodular appearance of gastric mucosa was observed in 75.00%cases in the UDT-CG group and 35.29%cases in the TDT-CG group.In the initial treatment,symptomatic therapy and hormonal therapy respectively relieved the symptoms in 75.00%(30/40)and 100%(3/3)cases in the UDT-CG group and 57.14%(4/7)and 83.33%(5/6)cases in the TDT-CG group.In the retreatment,symptomatic therapy and hormone therapy respectively achieved the remission rates of 100.00%(3/3)and 88.89%(8/9)in the UDT-CG group and 80.00%(4/5)and 66.67%(2/3)in the TDT-CG group.Conclusions CG,a rare disease of gastric collagen deposition,mainly occurs in young patients,and females are more susceptible than males.The clinical manifestations of CG are nonspecific,and anemia,abdominal pain,diarrhea,weight loss,and gastrointestinal bleeding are the common symptoms of CG.Nodular appearance of gastric mucosa is a relatively specific endoscopic feature of CG.There is no standardized treatment for CG.Symptomatic treatment is commonly adopted to improve the quality of life of the patients,and hormones can be added when necessary.