Alonso Núria, Granada M Luisa, Salinas Isabel, Lucas Ana M, Reverter Jordi L, Juncà Jordi, Oriol Albert, Sanmartí Ana
Department of Endocrinology and Nutrition, Hospital Universitari Germans Trias i Pujol, Ctra Canyet s/n, Badalona, 08916 Catalonia, Spain.
J Clin Endocrinol Metab. 2005 Sep;90(9):5254-8. doi: 10.1210/jc.2005-0580. Epub 2005 Jul 19.
Pernicious anemia (PA) is an autoimmune organ disease much more common in type 1 diabetic patients (DM1) than in nondiabetic subjects, but it is clinically silent until its end stage.
This study aimed to determine biochemical markers of latent PA in a population of DM1 patients attending the endocrinology outpatient clinic of a university hospital.
The population studied consisted of 186 unselected patients (32.4 +/- 8.7 yr) and 118 healthy controls (30.9 +/- 9.4 yr).
Plasma gastrin and pepsinogen I were determined in patients and controls, whereas hemoglobin A1c, serum cobalamin, hemoglobin, and organ-specific antibodies were determined only in patients. Latent PA was defined as serum pepsinogen I less than 30 microg/liter. In patients with low pepsinogen I concentrations and hypergastrinemia, esophagogastroduodenoscopy (EGD) was performed.
DM1 patients showed significantly lower pepsinogen I concentrations (P < 0.001) and higher gastrinemia than controls. Latent PA was present in 12.4% of patients vs. 0.9% of controls. Among patients, more women than men showed low plasma pepsinogen I concentrations (P = 0.002) and thyroperoxidase antibody positivity (P < 0.001). Only the highest parietal cell antibody titers (> or =1:640) identified patients with significantly higher levels of plasma gastrin (P < 0.001) and lower levels of pepsinogen I (P < 0.001). The histopathological EGD findings confirmed different degrees of gastric body mucosa atrophy in all cases.
The high prevalence of latent PA found in our DM1 patients leads us to recommend its screening using serum pepsinogen I concentrations. In patients with hypergastrinemia and high parietal cell antibody titers, EGD should be considered to confirm gastric mucosa atrophy.
恶性贫血（PA）是一种自身免疫性器官疾病，在1型糖尿病患者（DM1）中比在非糖尿病患者中更为常见，但在其终末期之前临床上并无症状。
本研究旨在确定在一家大学医院内分泌门诊就诊的DM1患者群体中潜在PA的生化标志物。
研究人群包括186例未经筛选的患者（32.4±8.7岁）和118例健康对照者（30.9±9.4岁）。
测定患者和对照者的血浆胃泌素和胃蛋白酶原I，而仅在患者中测定糖化血红蛋白A1c、血清钴胺素、血红蛋白和器官特异性抗体。潜在PA定义为血清胃蛋白酶原I低于30微克/升。对于胃蛋白酶原I浓度低且胃泌素血症高的患者，进行食管胃十二指肠镜检查（EGD）。
DM1患者的胃蛋白酶原I浓度显著低于对照组（P<0.001），胃泌素血症高于对照组。12.4%的患者存在潜在PA，而对照组为0.9%。在患者中，血浆胃蛋白酶原I浓度低的女性多于男性（P=0.002），甲状腺过氧化物酶抗体阳性率也更高（P<0.001）。只有最高的壁细胞抗体滴度（≥1:640）能识别出血浆胃泌素水平显著更高（P<0.001）和胃蛋白酶原I水平更低（P<0.001）的患者。EGD的组织病理学检查结果证实所有病例均有不同程度的胃体黏膜萎缩。
我们在DM1患者中发现的潜在PA高患病率使我们建议使用血清胃蛋白酶原I浓度进行筛查。对于胃泌素血症高且壁细胞抗体滴度高的患者，应考虑进行EGD以确认胃黏膜萎缩。
