Analysis of Clinical Characteristics of Autoimmune Gastritis:Single Center Retrospective Study

LIU Min; XIAO Wei; ZHANG Caifeng

doi:10.3969/j.issn.1004-437X.2025.07.004

Abstract：Objective To statistically analyze the clinica,endoscopic and pathological characteristics of autoimmune gastritis(AIG),and to improve clinical understanding and diagnosis and treatment level of AIG.Methods Data of 149 AIG patients who visited Henan Provincial People's Hospital from January 2018 to May 2023 were collected,including confirmed age,gender,clinical symptoms,serological tests,Helicobacter pylori(Hp)detection,comorbidities,gastroscopy,and pathological results.The collected results were analyzed and summarized.Results Among 149 patients,the age of diagnosis was 29-81 years old,the average age was(58.50±11.88)years old,and the female was more than the male(96 cases vs 53 cases).The common clinical symptoms were dyspepsia[82 cases(55.0％)],anemia[iron-deficiency anemia 46 cases(30.9％),megaloblastic anemia 20 cases(13.4％)],subacute combined degeneration of spinal cord[5 cases(3.4％)],and some patients were asymptomatic.Among 149 patients,131(87.9％)were positive for anti parietal cell antibodies(PCA)and 44(29.5％)were positive for anti-intrinsic factor antibodies(IFA).Both were positive in 29(19.5％)and negative in 2(1.3％).The patients included in this study were tested for gastric function by ELISA.Gastrin-17(G-17)was(55.64±29.27)pmol·L-1,pepsin Ⅰ(PG Ⅰ)was(52.84±18.42)μg·L-1,and ratio of PG Ⅰ to PG Ⅱ(PGR)was 6.14±3.63.Among them,117 patients underwent Hp testing,with the majority being negative[74 cases negative(49.7％)vs 43 cases positive(28.9％)vs 32 cases unknown(21.5％)].AIG was often associated with other autoimmune diseases,including 18 cases of autoimmune thyroiditis(12.1％),4 cases of autoimmune hepatitis(2.7％),4 cases of rheumatoid arthritis(2.7％),1 case of Sjogren's syndrome(0.7％),1 case of ankylosing spondylitis(0.7％),and 1 case of type Ⅰ diabetes(0.7％).Combined with endoscopic and pathological findings,59 cases(39.6％)of gastric polyps,6 cases(4.0％)of gastric cancer,38 cases(25.5％)of type Ⅰ gastric neuroendocrine tumor(g-NET),47 cases(31.5％)of intestinal metaplasia and 16 cases(10.7％)of endocrine cell micronest(ECM)were found pathologically.Further analysis was conducted to identify the risk factors for type Ⅰ g-NET in AIG patients.Univariate analysis showed that AIG patients with type Ⅰ g-NET was younger[(54.42±10.83)years vs(59.89±11.95)years],higher levels of G-17[62.37(46.31,86.01)pmol·L-1 vs 48.91(39.72,59.37)pmol·L],and a higher proportion of combined ECM[39.5％(15/38)vs 0.9％(1/111)],with statistically significant differences(P＜0.05).Multivariate logistic regression analysis showed that G-17(OR=1.020,95％CI:1.005-1.035)and ECM(OR=59.163,95％CI:7.250-482.774)were independent risk factors for AIG patients with type Ⅰ g-NET(P＜0.05).Receiver operating characteristic(ROC)analysis of G-17 predicting AIG combined with type Ⅰg-NET showed an optimal cutoff value of 60.32 pmol·L-1,sensitivity of 55.3％,and specificity of 80.2％.Conclusion When the following situations occur,further improvement in serology,gastroscopy,and pathological examination is necessary to exclude AIG:endoscopic appearance of"reverse atrophy",refractory anemia,and other autoimmune diseases.AIG patients are prone to developing type Ⅰ g-NET and gastric cancer.When there is G-17＞60.32 pmol·L-1 and ECM is present,it is necessary to be vigilant about the occurrence of type Ⅰ g-NET and closely monitor endoscopy.It is necessary to improve the diagnostic rate of AIG and reduce its missed and misdiagnosed rates through multidisciplinary collaboration.