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Article(id=1322954599207941071, tenantId=1146029695717560320, journalId=1319373162502258839, issueId=1322954407050092740, articleNumber=null, orderNo=null, doi=10.16016/j.2097-0927.202504120, pmid=null, cstr=null, oa=null, hot=null, price=null, onlineType=0, articleFormat=0, articleType=null, articleTypeStr=null, receivedDate=1745856000000, receivedDateStr=2025-04-29, revisedDate=1757952000000, revisedDateStr=2025-09-16, acceptedDate=null, acceptedDateStr=null, onlineDate=1793346555759, onlineDateStr=2026-10-30, pubDate=1760457600000, pubDateStr=2025-10-15, doiRegisterDate=null, doiRegisterDateStr=null, onlineIssueDate=1793346555759, onlineIssueDateStr=2026-10-30, onlineJustAcceptDate=null, onlineJustAcceptDateStr=null, onlineFirstDate=null, onlineFirstDateStr=null, sourceXml=null, magXml=null, createTime=1793346555759, creator=13701087609, updateTime=1793346555759, updator=13701087609, issue=Issue{id=1322954407050092740, tenantId=1146029695717560320, journalId=1319373162502258839, year='2025', volume='47', issue='19', pageStart='2289', pageEnd='2444', issueExtLink='null', onlineDate='null', pubDate='1760457600000', pubDateStr='2025-10-15', beforeIssueId=null, nextIssueId=null, price=null, status=1, issueComplete=1, articleOrder=1, issueType=-1, specialIssue=null, createTime=1793346509945, creator='13701087609', updateTime=1793346509945, updator='13701087609', preIssue=null, nextIssue=null, articleTotal=null, ext=null, issueFiles=null, downloadFileDto=null}, startPage=2396, endPage=2404, ext={EN=ArticleExt(id=1322954599434433488, articleId=1322954599207941071, tenantId=1146029695717560320, journalId=1319373162502258839, language=EN, title=Clinical characteristics and contributors to diagnostic delay in autoimmune gastritis, columnId=1320435174995772212, journalTitle=Journal of Army Medical University, columnName=Clinical Medicine, runingTitle=null, highlight=null, articleAbstract=
Objective

To analyze the diagnostic process and clinical characteristics of autoimmune gastritis(AIG) in order to improve the awareness and diagnostic proficiency of this disease.

Methods

A retrospective cohort study was conducted on 114 patients diagnosed with AIG in Army Medical Center of PLA between January 2021 and June 2024. Comprehensive statistical analysis was performed on clinical data, including demographic characteristics(age, sex), clinical symptoms, comorbidities, diagnostic process, Helicobacter pylori(H. pylori) infection and treatment history, laboratory indicators [results of routine blood test, anemia-related indices, thyroid function, anti-parietal cell antibody(APCA), intrinsic factor antibody(IFA)], and gastrointestinal endoscopic findings(frequency and endoscopic features).

Results

Among the 114 patients, males accounted for 28.1%(32/114) and females for 71.9%(82/114), and they were at a mean age of 56.3±8.4 years. Predominant symptoms included epigastric/upper abdominal pain(47.4%, 54/114) and postprandial fullness(43.0%, 49/114), while 24.6%(28/114) reported acid reflux or heartburn. Diagnostic delay occurred in 76.4%(87/114) of patients, with a median delay duration of 11.5 months. Primary diagnostic clues were endoscopic reverse gradient atrophy(significantly more severe mucosal atrophy in the gastric corpus/fundus versus antrum; 53.5%, 61/114) and repeated H. pylori eradication failure(≥2 attempts; 22.8%, 26/114). Positivity rate of thyroid peroxidase antibody(TPOAb) and thyroglobulin antibody(TgAb) was 56.9%(33/58) and 36.2%(21/58), respectively. APCA positive rate was 98.8%(81/82), IFA positive rate was 34.1%(28/82), and dual-antibody rate was 32.9%(27/82). Anemia was present in 25.7%(26/101) of the patients. Gastric neuroendocrine tumors(NET) were found in 12.2%(14/114), intraepithelial neoplasia in 5.3%(6/114), and gastric adenocarcinoma in 0.9%(1/114). Among colonoscopy-examined patients, tubular adenomas occurred in 25.0%(13/52) and colorectal malignancies in 3.4%(2/58). There were 18.4%(21/114) patients having gallbladder-related diseases, 7.9%(9/114) having diabetes mellitus, and 1.8%(2/114) of subacute combined degeneration of the spinal cord.

Conclusion

AIG is frequently associated with diagnostic delay. The reverse pattern of atrophy on endoscopy serves as a critical diagnostic clue, necessitating enhanced recognition in endoscopists. Patients with recurrent H. pylori eradication failure (≥2 attempts) should be evaluated for AIG.

, authors=Haofeng LI, He MA, Tao FU, Xinyi HUANG, Qing SHI, Yan ZHENG, Hanning LIU, Hengqi LIU, Yan GUO, Chunhui LAN, authorsList=Haofeng LI, He MA, Tao FU, Xinyi HUANG, Qing SHI, Yan ZHENG, Hanning LIU, Hengqi LIU, Yan GUO, Chunhui LAN, authorCompany=null, correspAuthors=Chunhui LAN, authorNote=null, correspAuthorsNote=null, copyrightStatement=© 2025 Journal of Army Medical University, copyrightOwner=Editorial Office of Journal of Army Medical University, extLink=null, articleAbsUrl=null, sourceXml=null, magXml=null, pdfUrl=null, pdf=null, pdfFileSize=null, pdfExtLink=null, richHtmlUrl=null, mobilePdfUrl=null, reviewReport=null, pdfFirstPage=null, abstractGraph=null, abstractGraphContent=null, abstractVideo=null, citation=null, cebUrl=null, magXmlContent=null, mapNumber=null, fund=null), CN=ArticleExt(id=1322954601816798165, articleId=1322954599207941071, tenantId=1146029695717560320, journalId=1319373162502258839, language=CN, title=自身免疫性胃炎的临床特征与诊断延迟因素, columnId=1320435175822050102, journalTitle=陆军军医大学学报, columnName=论著·临床医学, runingTitle=null, highlight=null, articleAbstract=
目的

分析自身免疫性胃炎（autoimmune gastritis，AIG）患者的诊断过程及临床特征，进一步提高对该疾病的认识和诊断水平。

方法

通过回顾性队列研究，纳入2021年1月至2024年6月陆军特色医学中心消化内科确诊的114例AIG患者，对其临床资料进行综合统计分析。包括：人口学特征（年龄、性别）、临床症状、共患疾病、诊断过程、幽门螺杆菌（Helicobacter pylori，H. pylori）感染及治疗史、实验室检查指标［血常规、贫血相关指标、甲状腺功能、抗胃壁细胞抗体（anti-parietal cell antibody，APCA）、内因子抗体（intrinsic factor antibody，IFA）］以及胃肠镜检查结果（检查频次及镜下表现）。

结果

114例患者中，男性占28.1%（32/114），女性占71.9%（82/114），平均年龄（56.3±8.4）岁。临床症状以中上腹痛（47.4%，54/114）及餐后饱胀（43.0%，49/114）为主，24.6%（28/114）伴反酸或烧心症状。76.4%（87/114）的患者存在AIG诊断延迟，诊断延迟中位时间为11.5个月，主要诊断线索为内镜下逆向萎缩（胃体/底部黏膜萎缩程度显著重于胃窦）现象（53.5%，61/114）及H. pylori反复根除失败（≥2次）（22.8%，26/114）。甲状腺过氧化物酶抗体（thyroid peroxidase antibody，TPOAb）阳性率为56.9%（33/58），甲状腺球蛋白抗体（thyroglobulin antibody，TgAb）阳性率为36.2%（21/58）。APCA阳性率高达98.8%（81/82），IFA阳性率为34.1%（28/82），双抗体共阳性率为32.9%（27/82）。25.7%（26/101）存在贫血。12.2%（14/114）检出胃神经内分泌肿瘤（neuroendocrine tumors，NET），5.3%（6/114）存在上皮内瘤变，1例（0.9%）确诊胃腺癌；结肠管状腺瘤占25.0%（13/52），结直肠恶性肿瘤占3.4%（2/58）。18.4%（21/114）存在胆囊相关疾病，7.9%（9/114）合并糖尿病，1.8%（2/114）出现脊髓亚急性联合变性。

结论

AIG诊断延迟发生率高，而内镜下逆向萎缩是AIG的重要诊断线索，需强化内镜医师对此征象的识别能力。对于H. pylori反复根除失败（≥2次）患者，需警惕AIG可能。

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兰春慧，E-mail：
LAN Chunhui，E-mail：
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PLoS Pathog，2017，13（11）：e1006653., articleTitle=Comparison of the human gastric microbiota in hypochlorhydric states arising as a result of Helicobacter pylori-induced atrophic gastritis，autoimmune atrophic gastritis and proton pump inhibitor use, refAbstract=null), Reference(id=1322954609492373557, tenantId=1146029695717560320, journalId=1319373162502258839, articleId=1322954599207941071, doi=10.3748/wjg.v30.i32.3783, pmid=null, pmcid=null, year=2024, volume=30, issue=32, pageStart=3783, pageEnd=3790, url=null, language=null, rfNumber=23, rfOrder=23, authorNames=ISAKOV V, journalName=World J Gastroenterol, refType=null, unstructuredReference=ISAKOV V. Autoimmune gastritis studies and gastric cancer：True renaissance or bibliometric illusion［J］. 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Biomedicines，2023，11（3）：828., articleTitle=Factors predicting type I gastric neuroendocrine neoplasia recurrence：a single-center study, refAbstract=null), Reference(id=1322954609723060280, tenantId=1146029695717560320, journalId=1319373162502258839, articleId=1322954599207941071, doi=10.1136/gutjnl-2022-327827, pmid=null, pmcid=null, year=2023, volume=72, issue=1, pageStart=30, pageEnd=38, url=null, language=null, rfNumber=26, rfOrder=26, authorNames=RUGGE M, BRICCA L, GUZZINATI S, journalName=Gut, refType=null, unstructuredReference=RUGGE M，BRICCA L，GUZZINATI S，et al. Autoimmune gastritis：long-term natural history in naïve Helicobacter pylori-negative patients［J］. 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J Investig Med，2022，70（1）：73-78., articleTitle=Prevalence and predictors of colonoscopic findings in patients with autoimmune gastritis, refAbstract=null), Reference(id=1322954609932775482, tenantId=1146029695717560320, journalId=1319373162502258839, articleId=1322954599207941071, doi=10.1186/s13062-024-00509-7, pmid=null, pmcid=null, year=2024, volume=19, issue=1, pageStart=75, pageEnd=null, url=null, language=null, rfNumber=28, rfOrder=28, authorNames=WANG X, SUN T J, FAN J P, journalName=Biol Direct, refType=null, unstructuredReference=WANG X，SUN T J，FAN J P，et al. Gastrin-related circRNA_0017065 promotes the proliferation and metastasis of colorectal cancer through the miR-3174/RBFOX2 axis［J］. Biol Direct，2024，19（1）：75., articleTitle=Gastrin-related circRNA_0017065 promotes the proliferation and metastasis of colorectal cancer through the miR-3174/RBFOX2 axis, refAbstract=null)], funds=null, companyList=[AuthorCompany(id=1322954602022319062, tenantId=1146029695717560320, journalId=1319373162502258839, articleId=1322954599207941071, xref=1, ext=[AuthorCompanyExt(id=1322954602030707671, tenantId=1146029695717560320, journalId=1319373162502258839, articleId=1322954599207941071, companyId=1322954602022319062, language=EN, country=null, province=null, city=null, postcode=null, companyName=null, departmentName=null, remark=1Department of Gastroenterology，Army Medical Center of PLA/Daping Hospital of Third Military Medical University，Chongqing，China), AuthorCompanyExt(id=1322954602039096280, tenantId=1146029695717560320, journalId=1319373162502258839, articleId=1322954599207941071, companyId=1322954602022319062, language=CN, country=null, province=null, city=null, postcode=null, companyName=null, departmentName=null, remark=1陆军特色医学中心（第三军医大学大坪医院）消化内科，重庆)])], figs=[ArticleFig(id=1322954606782853140, tenantId=1146029695717560320, journalId=1319373162502258839, articleId=1322954599207941071, language=EN, label=Figure 1, caption=Typical endoscopic findings of autoimmune gastritis, figureFileSmall=fqCa5Tudgz97CKBwhQeGmA==, figureFileBig=tb9Y/l7nU8F33vU91CNMZA==, tableContent=null), ArticleFig(id=1322954606870933525, tenantId=1146029695717560320, journalId=1319373162502258839, articleId=1322954599207941071, language=CN, label=图1, caption=自身免疫性胃炎内镜下典型表现

A：Marked atrophy of gastric body mucosa with submucosal vessel visualization（typical “reverse atrophy”）； B：No obvious atrophy of gastric antrum mucosa； C：Island-like residual fundic glands in the gastric body； D：Hyperplastic polyps in the gastric mucosa； E：Yellow-white dense adherent mucus on the gastric mucosa； F：Patchy or streaky mucosal erythema in the gastric body

, figureFileSmall=fqCa5Tudgz97CKBwhQeGmA==, figureFileBig=tb9Y/l7nU8F33vU91CNMZA==, tableContent=null), ArticleFig(id=1322954607059677206, tenantId=1146029695717560320, journalId=1319373162502258839, articleId=1322954599207941071, language=EN, label=Figure 2, caption=Typical endoscopic findings of gastric neuroendocrine tumor（NET）, figureFileSmall=r+ZGOLNgXZMua77JRGsXEQ==, figureFileBig=JwR01F4P61kG9TpGgRyvJw==, tableContent=null), ArticleFig(id=1322954607143563287, tenantId=1146029695717560320, journalId=1319373162502258839, articleId=1322954599207941071, language=CN, label=图2, caption=神经内分泌肿瘤典型内镜下表现

A：Pale red submucosal elevated lesion under white light endoscopy； B：Dilated cyan spiral subepithelial vessels（brain gyrus-like appearance） under magnifying endoscopy with narrow-band imaging（NBI）.

, figureFileSmall=r+ZGOLNgXZMua77JRGsXEQ==, figureFileBig=JwR01F4P61kG9TpGgRyvJw==, tableContent=null), ArticleFig(id=1322954607219060760, tenantId=1146029695717560320, journalId=1319373162502258839, articleId=1322954599207941071, language=EN, label=Table 1, caption=

Baseline characteristics in autoimmune gastritis patients and stratification with diagnostic delay［x¯±s，n（%）］

, figureFileSmall=null, figureFileBig=null, tableContent=
Clinical characteristicTotal cases
（n=114）		Diagnosis delayed group
（n=87）		Non-delayed diagnosis group
（n=27）
Age/years56.3±8.456.7±8.054.9±9.7
Gender
Female82（71.9）64（73.6）18（66.7）
Male32（28.1）23（26.4）9（33.3）
Clinical symptoms
Epigastric pain54（47.4）45（51.7）9（33.3）
Abdominal distension49（43.0）40（45.9）9（33.3）
Anxiety/depression symptoms33（28.9）30（34.5）3（11.1）
Acid reflux20（17.5）16（18.4）4（14.8）
Nausea12（10.5）8（9.2）4（14.8）
No obvious gastrointestinal symptoms20（17.5）8（9.2）12（44.4）
Heartburn11（9.6）7（8.0）4（14.8）
Limb numbness or paresthesia8（7.0）6（6.9）2（7.4）
H. pylori-related
Urea breath test positive（n=79）69（87.3）54（87.1）15（88.2）
Failed eradication treatment ≥1（n=63）55（87.3）42（84.0）13（100.0）
Failed eradication treatment ≥2（n=63）37（58.7）28（56.0）9（69.2）
Laboratory indicators
Anti-parietal cell antibody（APCA） positive（n=82）81（98.8）55（100.0）26（96.2）
Intrinsic factor antibody（IFA） positive（n=82）28（34.1）13（23.6）15（55.5）
APCA and IFA double positive（n=82）27（32.9）13（23.6）14（51.9）
Endoscopic findings
Gastric neuroendocrine tumor14（12.2）10（11.5）4（14.8）
Gastric intraepithelial neoplasia6（5.3）2（2.3）4（14.8）
Gastric adenocarcinoma1（0.9）1（1.1）0（0.0）
Colonoscopic tubular adenoma（n=52）13（25.0）11（22.4）2（15.4）
Colonoscopic colorectal malignant tumor（n=58）2（3.4）2（4.1）0（0）
Diagnostic clues
Gastric mucosal reverse atrophy61（53.5）44（50.6）17（63.0）
H. pylori repeated eradication failure（≥2）26（22.8）22（25.3）4（14.8）
Neuroendocrine cell hyperplasia13（11.4）12（13.8）1（3.7）
Gastric neuroendocrine tumor9（7.8）7（8.0）2（7.4）
Elevated gastrin level3（2.6）2（2.3）1（3.7）
Anemia2（1.7）02（7.4）
), ArticleFig(id=1322954607298752537, tenantId=1146029695717560320, journalId=1319373162502258839, articleId=1322954599207941071, language=CN, label=表1, caption=

AIG 患者基线特征与诊断延迟分组比较［x¯±s，例（%）］

, figureFileSmall=null, figureFileBig=null, tableContent=
Clinical characteristicTotal cases
（n=114）		Diagnosis delayed group
（n=87）		Non-delayed diagnosis group
（n=27）
Age/years56.3±8.456.7±8.054.9±9.7
Gender
Female82（71.9）64（73.6）18（66.7）
Male32（28.1）23（26.4）9（33.3）
Clinical symptoms
Epigastric pain54（47.4）45（51.7）9（33.3）
Abdominal distension49（43.0）40（45.9）9（33.3）
Anxiety/depression symptoms33（28.9）30（34.5）3（11.1）
Acid reflux20（17.5）16（18.4）4（14.8）
Nausea12（10.5）8（9.2）4（14.8）
No obvious gastrointestinal symptoms20（17.5）8（9.2）12（44.4）
Heartburn11（9.6）7（8.0）4（14.8）
Limb numbness or paresthesia8（7.0）6（6.9）2（7.4）
H. pylori-related
Urea breath test positive（n=79）69（87.3）54（87.1）15（88.2）
Failed eradication treatment ≥1（n=63）55（87.3）42（84.0）13（100.0）
Failed eradication treatment ≥2（n=63）37（58.7）28（56.0）9（69.2）
Laboratory indicators
Anti-parietal cell antibody（APCA） positive（n=82）81（98.8）55（100.0）26（96.2）
Intrinsic factor antibody（IFA） positive（n=82）28（34.1）13（23.6）15（55.5）
APCA and IFA double positive（n=82）27（32.9）13（23.6）14（51.9）
Endoscopic findings
Gastric neuroendocrine tumor14（12.2）10（11.5）4（14.8）
Gastric intraepithelial neoplasia6（5.3）2（2.3）4（14.8）
Gastric adenocarcinoma1（0.9）1（1.1）0（0.0）
Colonoscopic tubular adenoma（n=52）13（25.0）11（22.4）2（15.4）
Colonoscopic colorectal malignant tumor（n=58）2（3.4）2（4.1）0（0）
Diagnostic clues
Gastric mucosal reverse atrophy61（53.5）44（50.6）17（63.0）
H. pylori repeated eradication failure（≥2）26（22.8）22（25.3）4（14.8）
Neuroendocrine cell hyperplasia13（11.4）12（13.8）1（3.7）
Gastric neuroendocrine tumor9（7.8）7（8.0）2（7.4）
Elevated gastrin level3（2.6）2（2.3）1（3.7）
Anemia2（1.7）02（7.4）
), ArticleFig(id=1322954607403610138, tenantId=1146029695717560320, journalId=1319373162502258839, articleId=1322954599207941071, language=EN, label=Table 2, caption=

Logistic regression analysis of factors related to diagnostic delay in autoimmune gastritis

, figureFileSmall=null, figureFileBig=null, tableContent=
Related factorsRegression coefficientStandard errorOR（95%CI）P
No obvious gastrointestinal symptoms0.6930.6752.000（0.533~7.509）0.305
Failure to identify reverse atrophy in Initial gastroscopy1.8860.6366.596（1.897~22.929）0.003
No biopsy taken in Initial gastroscopy-0.2040.5670.816（0.268~2.481）0.720
First visit to non-gastroenterology department1.5870.7654.891（1.091~21.919）0.038
Without concurrent gastric neuroendocrine tumor-0.4650.6730.628（0.168~2.349）0.489
), ArticleFig(id=1322954607474913307, tenantId=1146029695717560320, journalId=1319373162502258839, articleId=1322954599207941071, language=CN, label=表2, caption=

自身免疫性胃炎诊断延迟相关因素的 Logistic 回归分析

, figureFileSmall=null, figureFileBig=null, tableContent=
Related factorsRegression coefficientStandard errorOR（95%CI）P
No obvious gastrointestinal symptoms0.6930.6752.000（0.533~7.509）0.305
Failure to identify reverse atrophy in Initial gastroscopy1.8860.6366.596（1.897~22.929）0.003
No biopsy taken in Initial gastroscopy-0.2040.5670.816（0.268~2.481）0.720
First visit to non-gastroenterology department1.5870.7654.891（1.091~21.919）0.038
Without concurrent gastric neuroendocrine tumor-0.4650.6730.628（0.168~2.349）0.489
), ArticleFig(id=1322954607550410780, tenantId=1146029695717560320, journalId=1319373162502258839, articleId=1322954599207941071, language=EN, label=Table 3, caption=

Lesion characteristics of 14 autoimmune gastritis patients with concurrent gastric neuroendocrine tumor

, figureFileSmall=null, figureFileBig=null, tableContent=
CaseGenderAge/yearsNumber of lesionsLocationGross typeMaximum lesion diameter/cmInfiltration depth
1Male471Greater curvature of gastric bodySuperficial Elevated type0.6Submucosal
2Female561Anterior wall of gastric bodySuperficial elevated type0.3Intramucosal
3Female521Greater curvature of gastric bodyFlat type0.4Intramucosal
4Female461Anterior wall of gastric bodySuperficial elevated type0.3Intramucosal
5Female611Anterior wall of gastric bodySuperficial elevated type0.5Intramucosal
6Male444Greater curvature of gastric bodyFlat + superficial elevated type0.6Muscularis Propria
7Male553Greater curvature of gastric bodySuperficial elevated type1.1Intramucosal
8Female657Lesser curvature of gastric bodySuperficial elevated type1.3Submucosal
9Female411Anterior wall of gastric bodySuperficial elevated type0.9Submucosal
10Female463Lesser curvature of gastric body+Gastric FundusSuperficial elevated type1.1Intramucosal
11Female551Greater curvature of gastric bodySuperficial elevated type1.0Submucosal
12Female571Anterior wall of gastric bodySuperficial elevated type0.5Submucosal
13Male663Greater curvature of gastric bodySuperficial elevated type1.0Muscularis Propria
14Male572Greater curvature of gastric body + posterior wall of gastric bodySuperficial elevated type0.9Intramucosal
), ArticleFig(id=1322954607621713949, tenantId=1146029695717560320, journalId=1319373162502258839, articleId=1322954599207941071, language=CN, label=表3, caption=

自身免疫性胃炎合并胃神经内分泌肿瘤患者14例的病变特征

, figureFileSmall=null, figureFileBig=null, tableContent=
CaseGenderAge/yearsNumber of lesionsLocationGross typeMaximum lesion diameter/cmInfiltration depth
1Male471Greater curvature of gastric bodySuperficial Elevated type0.6Submucosal
2Female561Anterior wall of gastric bodySuperficial elevated type0.3Intramucosal
3Female521Greater curvature of gastric bodyFlat type0.4Intramucosal
4Female461Anterior wall of gastric bodySuperficial elevated type0.3Intramucosal
5Female611Anterior wall of gastric bodySuperficial elevated type0.5Intramucosal
6Male444Greater curvature of gastric bodyFlat + superficial elevated type0.6Muscularis Propria
7Male553Greater curvature of gastric bodySuperficial elevated type1.1Intramucosal
8Female657Lesser curvature of gastric bodySuperficial elevated type1.3Submucosal
9Female411Anterior wall of gastric bodySuperficial elevated type0.9Submucosal
10Female463Lesser curvature of gastric body+Gastric FundusSuperficial elevated type1.1Intramucosal
11Female551Greater curvature of gastric bodySuperficial elevated type1.0Submucosal
12Female571Anterior wall of gastric bodySuperficial elevated type0.5Submucosal
13Male663Greater curvature of gastric bodySuperficial elevated type1.0Muscularis Propria
14Male572Greater curvature of gastric body + posterior wall of gastric bodySuperficial elevated type0.9Intramucosal
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自身免疫性胃炎的临床特征与诊断延迟因素
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李昊峰 , 马赫 , 符涛 , 黄心怡 , 施清 , 郑彦 , 刘瀚宁 , 刘恒琦 , 郭严 , 兰春慧
陆军军医大学学报 | 论著·临床医学 2025,47(19): 2396-2404
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陆军军医大学学报 |论著·临床医学 2025 , 47 (19) : 2396 -2404
自身免疫性胃炎的临床特征与诊断延迟因素
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李昊峰, 马赫, 符涛, 黄心怡, 施清, 郑彦, 刘瀚宁, 刘恒琦, 郭严, 兰春慧
作者信息
  • 1陆军特色医学中心（第三军医大学大坪医院）消化内科，重庆
通讯作者:
兰春慧，E-mail：
LAN Chunhui，E-mail：
Clinical characteristics and contributors to diagnostic delay in autoimmune gastritis
Haofeng LI, He MA, Tao FU, Xinyi HUANG, Qing SHI, Yan ZHENG, Hanning LIU, Hengqi LIU, Yan GUO, Chunhui LAN
Affiliations
  • 1Department of Gastroenterology，Army Medical Center of PLA/Daping Hospital of Third Military Medical University，Chongqing，China
出版时间: 2025-10-15 doi: 10.16016/j.2097-0927.202504120
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摘要
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目的

分析自身免疫性胃炎（autoimmune gastritis，AIG）患者的诊断过程及临床特征，进一步提高对该疾病的认识和诊断水平。

方法

通过回顾性队列研究，纳入2021年1月至2024年6月陆军特色医学中心消化内科确诊的114例AIG患者，对其临床资料进行综合统计分析。包括：人口学特征（年龄、性别）、临床症状、共患疾病、诊断过程、幽门螺杆菌（Helicobacter pylori，H. pylori）感染及治疗史、实验室检查指标［血常规、贫血相关指标、甲状腺功能、抗胃壁细胞抗体（anti-parietal cell antibody，APCA）、内因子抗体（intrinsic factor antibody，IFA）］以及胃肠镜检查结果（检查频次及镜下表现）。

结果

114例患者中，男性占28.1%（32/114），女性占71.9%（82/114），平均年龄（56.3±8.4）岁。临床症状以中上腹痛（47.4%，54/114）及餐后饱胀（43.0%，49/114）为主，24.6%（28/114）伴反酸或烧心症状。76.4%（87/114）的患者存在AIG诊断延迟，诊断延迟中位时间为11.5个月，主要诊断线索为内镜下逆向萎缩（胃体/底部黏膜萎缩程度显著重于胃窦）现象（53.5%，61/114）及H. pylori反复根除失败（≥2次）（22.8%，26/114）。甲状腺过氧化物酶抗体（thyroid peroxidase antibody，TPOAb）阳性率为56.9%（33/58），甲状腺球蛋白抗体（thyroglobulin antibody，TgAb）阳性率为36.2%（21/58）。APCA阳性率高达98.8%（81/82），IFA阳性率为34.1%（28/82），双抗体共阳性率为32.9%（27/82）。25.7%（26/101）存在贫血。12.2%（14/114）检出胃神经内分泌肿瘤（neuroendocrine tumors，NET），5.3%（6/114）存在上皮内瘤变，1例（0.9%）确诊胃腺癌；结肠管状腺瘤占25.0%（13/52），结直肠恶性肿瘤占3.4%（2/58）。18.4%（21/114）存在胆囊相关疾病，7.9%（9/114）合并糖尿病，1.8%（2/114）出现脊髓亚急性联合变性。

结论

AIG诊断延迟发生率高，而内镜下逆向萎缩是AIG的重要诊断线索，需强化内镜医师对此征象的识别能力。对于H. pylori反复根除失败（≥2次）患者，需警惕AIG可能。

自身免疫性胃炎  /  幽门螺杆菌  /  逆向萎缩  /  诊断延迟  /  神经内分泌肿瘤
Objective

To analyze the diagnostic process and clinical characteristics of autoimmune gastritis(AIG) in order to improve the awareness and diagnostic proficiency of this disease.

Methods

A retrospective cohort study was conducted on 114 patients diagnosed with AIG in Army Medical Center of PLA between January 2021 and June 2024. Comprehensive statistical analysis was performed on clinical data, including demographic characteristics(age, sex), clinical symptoms, comorbidities, diagnostic process, Helicobacter pylori(H. pylori) infection and treatment history, laboratory indicators [results of routine blood test, anemia-related indices, thyroid function, anti-parietal cell antibody(APCA), intrinsic factor antibody(IFA)], and gastrointestinal endoscopic findings(frequency and endoscopic features).

Results

Among the 114 patients, males accounted for 28.1%(32/114) and females for 71.9%(82/114), and they were at a mean age of 56.3±8.4 years. Predominant symptoms included epigastric/upper abdominal pain(47.4%, 54/114) and postprandial fullness(43.0%, 49/114), while 24.6%(28/114) reported acid reflux or heartburn. Diagnostic delay occurred in 76.4%(87/114) of patients, with a median delay duration of 11.5 months. Primary diagnostic clues were endoscopic reverse gradient atrophy(significantly more severe mucosal atrophy in the gastric corpus/fundus versus antrum; 53.5%, 61/114) and repeated H. pylori eradication failure(≥2 attempts; 22.8%, 26/114). Positivity rate of thyroid peroxidase antibody(TPOAb) and thyroglobulin antibody(TgAb) was 56.9%(33/58) and 36.2%(21/58), respectively. APCA positive rate was 98.8%(81/82), IFA positive rate was 34.1%(28/82), and dual-antibody rate was 32.9%(27/82). Anemia was present in 25.7%(26/101) of the patients. Gastric neuroendocrine tumors(NET) were found in 12.2%(14/114), intraepithelial neoplasia in 5.3%(6/114), and gastric adenocarcinoma in 0.9%(1/114). Among colonoscopy-examined patients, tubular adenomas occurred in 25.0%(13/52) and colorectal malignancies in 3.4%(2/58). There were 18.4%(21/114) patients having gallbladder-related diseases, 7.9%(9/114) having diabetes mellitus, and 1.8%(2/114) of subacute combined degeneration of the spinal cord.

Conclusion

AIG is frequently associated with diagnostic delay. The reverse pattern of atrophy on endoscopy serves as a critical diagnostic clue, necessitating enhanced recognition in endoscopists. Patients with recurrent H. pylori eradication failure (≥2 attempts) should be evaluated for AIG.

autoimmune gastritis  /  Helicobacter pylori  /  reverse atrophy  /  diagnostic delay  /  neuroendocrine tumor
李昊峰, 马赫, 符涛, 黄心怡, 施清, 郑彦, 刘瀚宁, 刘恒琦, 郭严, 兰春慧. 自身免疫性胃炎的临床特征与诊断延迟因素. 陆军军医大学学报, 2025 , 47 (19) : 2396 -2404 . DOI: 10.16016/j.2097-0927.202504120
Haofeng LI, He MA, Tao FU, Xinyi HUANG, Qing SHI, Yan ZHENG, Hanning LIU, Hengqi LIU, Yan GUO, Chunhui LAN. Clinical characteristics and contributors to diagnostic delay in autoimmune gastritis[J]. Journal of Army Medical University, 2025 , 47 (19) : 2396 -2404 . DOI: 10.16016/j.2097-0927.202504120
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自身免疫性胃炎（autoimmune gastritis，AIG）是1973年由STRICKLAND和MACKAY提出的胃体特异性慢性炎症性疾病［1］。其核心病理机制是：自身免疫性攻击引起胃壁细胞破坏、内因子分泌缺失及胃体/底部黏膜进行性萎缩［2］。该疾病可通过双重代谢途径引发血液系统异常：一方面胃酸分泌障碍导致铁吸收不良性缺铁性贫血；另一方面，内因子缺乏，使维生素B12吸收障碍，诱发巨幼细胞性贫血（即恶性贫血）［3］。此外，AIG患者的神经内分泌肿瘤（neuroendocrine tumor，NET）发生率升高，其年累积发病率约为5.7%［4］。
全球范围内AIG的流行病学数据存在显著异质性。基于组织学与血清学联合确诊的横断面研究显示，普通人群患病率为0.3%~2.7%，在女性及老年（≥60岁）群体中更为常见［5-6］。北京大学第三医院2013至2020年胃镜数据分析（n=3 500）显示，AIG年检出率为0.9%，其中女性占比64.4%（P<0.05）［7］。AIG误诊及诊断延迟的现象普遍［8-9］，一项国内研究（n=40）指出AIG患者的误诊率高达61.5%［10］。这可能归因于：①约70%患者缺乏典型症状；②内镜与病理诊断标准尚未统一；③血清抗壁细胞抗体（anti-parietal cell antibody，APCA）及内因子抗体（intrinsic factor antibody，IFA）检测尚未普及［5，11］。
如何早期确诊AIG是临床面临的挑战，尽管近年来发布的《日本自身免疫性胃炎的诊断标准及内镜和组织学表现》为AIG的临床诊断提供了初步规范［12］，但该标准是否适用于中国人群仍存争议，我国目前尚未发表相关共识或指南。由于AIG无特异性症状，临床医师对AIG的认识水平参差不齐，确诊需要结合胃镜、组织病理学与血清学抗体检测结果［13］，导致AIG误诊和漏诊较高。一项队列研究数据显示，AIG患者从症状出现到最终确诊的中位时间可达14个月［10］，这有可能加剧贫血、胃黏膜萎缩进展、NET或其他肿瘤性病变的发生风险，同时增加患者反复就医的经济负担和精神压力。
本研究旨在探讨AIG的临床特征及诊断过程，以进一步提高对该疾病认识和诊断水平。
1　对象与方法
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1.1　研究对象
本研究采用回顾性队列设计，纳入2021年1月至2024年6月期间于陆军特色医学中心消化内科确诊的114例AIG患者。纳入标准：① 年龄≥18岁；② 符合AIG诊断的2条标准［12］：内镜特征，胃体/底部黏膜萎缩程度显著重于胃窦部（即“逆向萎缩”现象）；血清学或病理学证据，抗壁细胞抗体和/或抗内因子抗体阳性，或组织病理学显示胃体/底部黏膜固有腺体减少、ECL细胞增生及内分泌细胞微小胞巢形成；③ 临床资料完整。当内镜表现与病理结果不一致时，以血清学结果联合病理特征作为确诊依据。排除标准：① 既往胃切除术史；② 合并其他自身免疫性疾病（如系统性红斑狼疮、类风湿关节炎）；③ 恶性肿瘤化疗史；④ 关键资料缺失。本研究通过陆军特色医学中心伦理委员会审核批准［医研伦审（2024）第270号］，并在中国临床试验注册中心进行注册（ChiCTR2400089743）。
1.2　研究方法
1.2.1　数据采集与诊断标准
通过检索陆军特色医学中心内镜中心图像管理系统及门诊病历系统，纳入确诊的AIG患者，采集数据包括：①人口学特征（性别、年龄）；②临床表现（消化道症状及消化道外症状）；③实验室指标（血常规、维生素B12、叶酸、甲状腺功能、APCA、IFA等）；④内镜特征（镜下表现、检查次数等）；⑤H. pylori诊断治疗情况（尿素呼气试验、治疗史、培养及组织学结果等）；⑥共患病情况。
1.2.2　诊断延迟时间计算
以首次胃镜提示胃体/底萎缩至确诊AIG的时间间隔为诊断延迟时间，若两者时间一致则提示诊断无延迟。
1.2.3　诊断线索定义
将确诊或拟诊AIG时的主要症状、体征或检查结果定义为诊断线索。
1.2.4　幽门螺杆菌（Helicobacter pylori，H. pylori）阳性的判断
①13C或14C尿素呼气试验阳性；②细菌培养：胃窦/胃体活检组织接种于含5%绵羊血选择性培养基，置于三气培养箱中（85%氮气、10%二氧化碳、5%氧气）培养96 h，尿素酶/氧化酶/过氧化氢酶三联阳性判定H. pylori阳性；③组织学检测：按悉尼胃炎分类系统［14］，镜下检出典型H. pylori形态。
1.2.5　疾病定义
恶性贫血的诊断标准［15］为：平均红细胞体积（mean corpuscular volume，MCV）>100 fL，IFA阳性，维生素B12<200 pg/mL。
1.3　统计学分析
应用SPSS27.0软件进行统计学分析。呈正态分布的计量资料以x¯±s表示；呈偏态分布的计量资料以M（P25，P75）表示，计数资料以例数和百分数表示。各种相关因素的分析采用多因素Logistic回归分析。P<0.05为差异具有统计学意义。
2　结果
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2.1　人口学特征
共纳入114例AIG确诊病例。以女性为主（71.9%，82/114），平均年龄（56.3±8.4）岁（范围：39~77岁）。
2.2　临床表现
消化道症状方面，中上腹痛（47.4%）与腹胀（43.0%）为主要临床表现，其次为反酸（17.5%）或烧心（9.6%）。此外，28.9%患者合并焦虑/抑郁症状，7.0%患者伴有肢体感觉异常等神经系统症状。另有17.5%患者无消化道症状（表1）。
2.3　诊断过程
114例AIG患者中，初次就诊科室分布如下：消化内科占比最高103例（90.3%），其次为中医科3例（2.6%）、胃肠外科与血液科2例（各1.7%），心内科、康复科、急诊科及全科医学科均为1例（各0.8%）。从首次就诊至最终确诊AIG，所需门诊中位次数为3（IQR：2~6）次。
AIG 患者的诊断线索分布显示，胃黏膜逆向萎缩61例（53.5%）和H. pylori反复根除失败（≥2次）26例（22.8%）最为常见，其余诊断线索按占比从高到低依次为神经内分泌细胞增生13例（11.4%）、胃神经内分泌肿瘤9例（7.8%）、胃泌素水平升高3例（2.6%）及贫血2例（1.7%），见表1。
患者平均接受（2.2±1.2）次胃镜检查，其中27例（23.6%）于首次胃镜检查时确诊，而87例（76.4%）存在诊断延迟（表1）：延迟≥1年者57例（65.5%），≥3年者17例（19.5%），1例（1.1%）延迟≥5年。诊断延迟中位时间为11.5个月（IQR：1~24）。
2.4　诊断延迟因素的多元Logistic回归分析
Logistic回归分析显示，首次胃镜未识别逆萎缩现象（OR=6.59，P=0.003）以及首诊非消化内科（OR=4.89，P=0.038）是诊断延迟的独立危险因素（表2）。AIG诊断延迟Logistic回归分析的变量包含因变量与自变量，均为二分类变量。其中，因变量存在诊断延迟，赋值规则为：1=存在诊断延迟，0=不存在诊断延迟；自变量共5个，分别为“无明显消化道症状”“首次胃镜未识别逆向萎缩”“首次胃镜未取活检”“首诊非消化内科”“未合并胃神经内分泌肿瘤”，各变量赋值规则均为：1=符合该变量描述（即无明显消化道症状、首次胃镜未识别逆向萎缩、首次胃镜未取活检、首诊科室非消化内科、未合并胃神经内分泌肿瘤），0=不符合该变量描述（即存在明显消化道症状、首次胃镜识别逆向萎缩、首次胃镜取活检、首诊科室为消化内科、合并胃NET）。
2.5　 H. pylori治疗史
114例AIG患者，尿素呼气试验阳性率为87.3%（69/79），呼气试验阳性的患者中，H. pylori培养阳性率为22.2%（4/18），病理组织学检查阳性率为7.4%（4/54）。在65例尿素呼气试验阳性且接受规范根除治疗的患者中，58例完成末次治疗后复查（7例失访），基于尿素呼气试验结果，最终H. pylori根除率为19.0%（11/58）。
此外，在63例接受过H. pylori根除治疗且进行过尿素呼气试验复查的患者中，87.3%（55/63）的H. pylori感染患者经历≥1次根除失败，其中58.7%（37/63）患者经历≥2次根除失败（表1），根除失败≥2次的37名患者中，病理组织学检查阳性率为8.3%（3/36），H. pylori培养阳性率为26.7%（4/15）。
2.6　胃肠镜检查结果
2.6.1　胃镜检查结果
114例AIG患者胃镜下特征分析显示：所有病例均呈现特征性“逆向萎缩”，即胃底/体部黏膜显著萎缩伴黏膜下血管透见（114/114，100%，图1A），而胃窦黏膜未见萎缩或仅轻度萎缩（图1B）。其余伴随性改变包括：胃体/底部岛状残存胃底腺（47/114，41.2%，图1C）、增生性息肉（15/114，13.2%，图1D）、黄白色致密附着性黏液（44/114，38.5%，图1E）、点片状/条索状黏膜红斑（10/114，8.8%，图1F）。
胃息肉样病变总检出率为41.2%（47/114），其中多发性息肉占比72.3%（34/47）。对42例完成病理评估的息肉标本分析显示：胃底腺息肉构成比最高（66.7%，28/42），其次为增生性息肉（35.7%，15/42），而管状腺瘤（2.4%，1/42）和幽门腺腺瘤（2.4%，1/42）较为罕见。其中，17.0%（8/47）的息肉患者存在两种及以上病理类型共存现象。
上消化道肿瘤性病变检出率20.2%（23/114），其中，12.2%（14/114）为NET，男性5例（35.7%），女性9例（64.2%），平均年龄（53.4±7.8）岁。胃NET白光内镜下观察呈淡红色黏膜下隆起性病变，放大内镜窄带成像模式下可见扩张呈脑回样的青色螺旋状上皮下血管（图2）。病变平均最大直径0.75 cm，病变数量中位数为1（IQR：1~3）处；浸润深度以黏膜内为主（50.0%，7/14），其次为黏膜下层（35.7%，5/14）及肌层（14.3%，2/14），见表3。此外，5.3%（6/114）患者存在上皮内瘤变（食管低级别1例，胃高级别2例，胃低级别3例），均接受内镜黏膜下剥离术（endoscopic submucosal dissection，ESD）治疗；其他病变包括平滑肌瘤（0.9%，1/114）及钙化性纤维性肿瘤（0.9%，1/114）。1例（0.9%）胃腺癌患者内镜下表现为胃体粗蒂腺瘤样病变（直径5.0 cm），ESD术后病理提示绒毛状-管状腺瘤伴中分化腺癌变，分期为T1N0M0。
2.6.2　结肠镜检查结果
58例患者接受结肠镜检查，总体病变检出率为56.9%（33/58）。其中息肉样病变为主要病变类型，检出率为46.6%（27/58）。52例患者接受病理评估，病理分型显示，管状腺瘤占比最高（25.0%，13/52），其次依次为增生性息肉（15.4%，8/52）、炎性息肉（7.7%，4/52）及脂肪瘤（3.8%，2/52），部分患者存在多病理类型共存（9.6%，5/52）。此外，结直肠炎症/溃疡检出率为10.3%（6/58）。恶性肿瘤检出2例（3.4%，2/58），1例直肠腺癌（4.6 cm×3.8 cm×1.3 cm）行腹腔镜下直肠癌根治术，术后病理证实为溃疡型中分化腺癌（pT3bN2aM0期），肿瘤浸润至浆膜下层；另1例升结肠腺癌（6.9 cm×6.4 cm×2.5 cm）行右半结肠根治性切除术，病理诊断为溃疡型高分化腺癌（pT3N0M0期），肿瘤累及浆膜下层。
2.7　实验室检查结果
AIG自身抗体检测显示，APCA阳性率为98.8%（81/82），IFA阳性率为34.1%（28/82），双抗体均阳性的占比为32.9%（27/82）。甲状腺相关自身抗体检测结果如下：66例接受甲状腺抗体检测的患者中，甲状腺过氧化物酶抗体（TPOAb）阳性率为56.9%（33/58），甲状腺球蛋白抗体（TgAb）阳性率为36.2%（21/58）；甲状腺功能评估发现33.3%（25/75）存在甲状腺功能异常。
贫血相关指标显示：66例接受维生素B12水平检测的患者中，血清维生素B12水平中位数值为109.53（IQR：62.8~240.0） pg/mL（n=66，正常参考值≥133 pg/mL），其中57.6%（38/66）低于正常下限；61例接受叶酸水平检测的患者中，血清叶酸水平中位数值为47.20（IQR：37.0~53.3） nmol/L（n=61，正常参考值≤45.1 nmol/L），55.7%（34/61）超过正常上限。
2.8　AIG并存疾病
101例接受贫血检测的AIG患者中，25.7%（26/101）存在贫血；其中，巨幼细胞性贫血占9.2%（6/65），缺铁性贫血占14.6%（6/41），其中符合恶性贫血诊断标准者10.9%（6/55）。其他共存的疾病分布如下：18.4%（21/114）存在胆囊相关疾病（含胆囊结石、胆囊息肉及胆囊切除术后状态），7.9%（9/114）合并糖尿病，1.8%（2/114）出现脊髓亚急性联合变性。
3　讨论
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本研究中76.4%的AIG患者存在诊断延迟（中位时间11.5个月），其中17.5%患者无消化道症状，有消化道症状的患者中，大部分主诉为中上腹痛、腹胀，这些临床表现无特异性，与功能性消化不良、消化性溃疡等症状高度重叠［16］，因此临床医生往往予以抑酸、保护胃黏膜及促动力等对症处理，未再进行进一步检查，这是引起诊断延迟的原因之一。其次，内镜医生的认识不足或观察不仔细也是导致诊断延迟的因素。Logistic回归分析显示，首次胃镜未识别逆萎缩现象（OR=6.59， P=0.003）是导致诊断延迟的独立危险因素，同样，内镜下胃黏膜逆向萎缩也是AIG最重要的诊断线索，但仅有23.6%患者于首次胃镜检查时被识别和确诊，部分内镜医师观察到胃窦黏膜无萎缩的表现，往往忽略对胃体胃底的观察；如果发现胃窦有萎缩，大部分医生会先入为主地考虑H. pylori感染导致的萎缩性胃炎，而没有仔细观察胃体/底部岛状残存胃底腺、增生性息肉、黄白色致密附着性黏液等AIG的相关表现。针对上述原因导致的AIG的诊断延迟，今后需强化内镜医师对AIG的形态学识别能力，并按照悉尼系统推荐规范化活检以提高病理检出率［14］。此外，首诊科室的误诊也是导致诊断延迟的核心环节，需加强全科医生对AIG的筛查意识。
本研究还发现，反复H. pylori根除治疗失败也是AIG的重要诊断线索。目前，H. pylori与AIG的关系仍未完全阐明。有研究显示H. pylori感染抑制了AIG的疾病进展，是AIG的保护因素［17］，但也有报道根除H. pylori后，AIG引起的萎缩有所缓解［18］，二者结论不一。在本研究中，AIG患者合并H. pylori感染的共69例，其中58.7%（37/63）的患者在采用符合国际共识［19-20］的14 d的铋剂四联或高剂量双联方案治疗后，仍经历至少2次失败，而这37名患者中，病理组织学检查阳性率仅为8.3%（3/36），H. pylori培养阳性率为26.7%（4/15）。推测原因如下：AIG的低酸环境促进非H. pylori的尿素酶阳性菌（如链球菌属）定植，导致呼气试验假阳性，出现反复治疗仍“失败”的“泥沼除菌”现象［21］。AIG患者胃微生物组特征分析显示胃内链球菌科丰度显著升高［22］。因此，对H. pylori反复根除失败病例，需进一步结合患者是否合并贫血、甲状腺疾病、中重度胃黏膜萎缩等情况，判断有无AIG，如果存在AIG，则不宜再使用尿素呼气试验或快速尿素酶检测，而是通过H. pylori培养、病理组织学检测、分子生物学、血清抗体、粪便抗原等其他手段明确H. pylori感染状态，避免不必要的抗菌治疗引发的不良反应、耐药风险、心理及经济负担。
AIG患者的肿瘤性病变风险升高。本研究显示，胃NET（12.2%）、上皮内瘤变（5.3%）及结直肠腺瘤（25.0%）的检出率较高。AIG患者的肿瘤风险主要源于NET［23］，其机制是：长期低胃酸状态引发持续性高胃泌素血症，驱动了ECL细胞增殖及肿瘤性转化［24］。本研究中NET浸润深度以黏膜内为主（50.0%），提示早期内镜干预（如ESD）可有效控制病变进展，但需警惕术后复发风险（5年复发率可达48.1%［25］）。AIG并未增加胃癌的发生风险，继往观察到AIG患者出现胃癌，可能与同时合并H. pylori感染相关［26］。而本研究中结直肠癌检出率为3.4%，ASFUROGLU等［27］一项大样本的研究显示，AIG患者结直肠肿瘤性病变发生率显著高于对照组（26.6% vs 6.6%，P<0.001），其风险与血清胃泌素（OR=8.59）和嗜铬粒蛋白A（OR=6.79）水平升高密切相关。有研究表明，胃泌素通过circRNA_0017065-miR-3174-RBFOX2轴促进结直肠肿瘤细胞的增殖及迁移，并抑制肿瘤细胞凋亡，进而驱动结直肠癌进展［28］。这也支持将结肠镜纳入AIG常规监测体系，尤其是对高胃泌素血症（>500 pg/mL）或血CgA升高（>100 ng/mL）的患者。
本研究存在下述局限性：这是一项单中心的回顾性研究，结果可能有选择性偏倚；诊断延迟时间计算受回忆偏倚影响，且以首次胃镜时间而不是从症状出现至确诊时间来定义诊断延迟时间，可能会低估实际延迟；因H. pylori培养及组织学检测未常规开展，阳性率可能存在抽样偏差；结肠镜检查未覆盖全部病例，可能低估结直肠肿瘤风险，AIG与结直肠肿瘤风险之间的相关性仍需要扩大样本量进一步明确；AIG患者泥沼除菌的具体机制、胃微生物组的分布、与H. pylori的关系，值得深入探讨。
综上所述，为了提高对AIG的诊断和管理水平，需要强化内镜医师对逆向萎缩的识别能力，加强标准化活检操作；对H. pylori反复根除失败病例，需警惕AIG可能性，同时避免泥沼除菌；将结肠镜纳入AIG患者监测项目，以筛查结直肠肿瘤。

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2025年第47卷第19期
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doi: 10.16016/j.2097-0927.202504120
  • 接收时间：2025-04-29
  • 首发时间：2026-10-30
  • 出版时间：2025-10-15
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  • 收稿日期：2025-04-29
  • 修回日期：2025-09-16
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    1陆军特色医学中心（第三军医大学大坪医院）消化内科，重庆

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兰春慧，E-mail：
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鹅膏菌科Amanitaceae 2 11 5.26 鹅膏菌属 Amanita 10 4.78
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红菇科 Russulaceae 3 23 11.00 小皮伞属 Marasmius 6 2.87
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光柄菇属 Pluteus 5 2.39
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