Marignani M, Delle Fave G, Mecarocci S, Bordi C, Angeletti S, D'Ambra G, Aprile M R, Corleto V D, Monarca B, Annibale B
Gastroenterology Department, Università degli Studi di Roma La Sapienza, Italy.
Am J Gastroenterol. 1999 Mar;94(3):766-72. doi: 10.1111/j.1572-0241.1999.00949.x.
Atrophic body gastritis (ABG) is characterized by atrophy of the gastric body mucosa, hypergastrinemia, and hypo/achlorhydria. Its association with pernicious anemia is well recognized. Gastric hypo/achlorhydria is known to affect iron absorption but ABG is rarely considered as a possible cause of iron deficiency (microcytic) anemia. The aims of this study were to validate a screening methodology for the detection of ABG in a consecutive series of patients with microcytic and macrocytic anemia and to investigate the clinical and gastric morphofunctional characteristics of the two hematological presentations of ABG.
A two-part prospective study was carried out. Part A aimed to validate the screening methodology to detect the presence of ABG in patients with macrocytic and microcytic anemia who have no specific GI symptoms, by measuring their gastrin levels and verified by performing gastroscopy with biopsy. Part B aimed to detect the presence of ABG in a larger sample of anemic patients by our validated method and, by pooling the data of ABG patients, to determine the clinical, gastric histological, and functional characteristics pertaining to the macrocytic and microcytic presentations of ABG.
In part A, ABG was detected in 37.5% of patients with macrocytic and in 19.5% of those with microcytic anemia. Pooling the data of the ABG patients from part A and part B, microcytic ABG patients were on average 20 yr younger than those with macrocytic anemia. The majority of microcytic ABG patients were female, most of whom were premenopausal. H. pylori infection was widely represented in the microcytic ABG group (61.1%). They also had a lesser grade of body mucosal atrophy and lower hypergastrinemia levels, suggesting a less severe oxyntic damage of shorter duration.
Macrocytic anemia is not the only hematological presentation of ABG. Physicians evaluating patients with unexplained iron deficiency anemia should consider ABG as a possible cause by determining fasting gastrin levels and performing gastroscopy with biopsies of the body mucosa.
萎缩性胃体胃炎（ABG）的特征为胃体黏膜萎缩、高胃泌素血症以及胃酸过少/无酸。其与恶性贫血的关联已得到充分认识。已知胃酸过少/无酸会影响铁的吸收，但ABG很少被视为缺铁（小细胞性）贫血的可能病因。本研究的目的是验证一种筛查方法，用于在一系列连续性小细胞性和大细胞性贫血患者中检测ABG，并研究ABG这两种血液学表现的临床及胃形态功能特征。
进行了一项分为两部分的前瞻性研究。A部分旨在通过测量胃泌素水平并经胃镜活检证实，验证在无特定胃肠道症状的大细胞性和小细胞性贫血患者中检测ABG存在的筛查方法。B部分旨在通过我们验证的方法在更大样本的贫血患者中检测ABG的存在，并通过汇总ABG患者的数据，确定与ABG大细胞性和小细胞性表现相关的临床、胃组织学及功能特征。
在A部分中，大细胞性贫血患者中有37.5%检测出ABG，小细胞性贫血患者中有19.5%检测出ABG。汇总A部分和B部分ABG患者的数据，小细胞性ABG患者的平均年龄比大细胞性贫血患者小20岁。大多数小细胞性ABG患者为女性，其中大多数处于绝经前。幽门螺杆菌感染在小细胞性ABG组中广泛存在（61.1%）。他们的胃体黏膜萎缩程度较轻，高胃泌素血症水平较低，提示胃底腺损伤程度较轻且持续时间较短。
大细胞性贫血并非ABG唯一的血液学表现。评估不明原因缺铁性贫血患者的医生应通过测定空腹胃泌素水平并对胃体黏膜进行活检来考虑ABG作为可能病因。
