Greenwood Deanne L V, Crock Patricia, Braye Stephen, Davidson Patricia, Sentry John W
Department of Medicine, Central and Eastern Clinical School, Monash University, Prahran, Victoria, 3181, Australia.
Eur J Pediatr. 2008 Aug;167(8):917-25. doi: 10.1007/s00431-007-0664-z. Epub 2008 Jan 24.
Autoimmune gastritis is characterised by lymphocytic infiltration of the gastric submucosa, with loss of parietal and chief cells and achlorhydria. Often, gastritis is expressed clinically as cobalamin deficiency with megaloblastic anaemia, which is generally described as a disease of the elderly. Here, we report on two prepubertal children who developed autoimmune gastritis. One child developed autoimmune gastritis as part of a polyglandular autoimmune disease from a family with polyglandular autoimmune disease type II (PGA type II) and the other as part of a classic "thyro-gastric cluster," which may have been triggered by emotional trauma. Both children presented with normal small bowel biopsies, with abnormal gut permeability, which subsequently resolved. These patients are among the youngest reported to date. The immune systems targetted the gastric parietal cell autoantigens (ATP4A and ATP4B) in both children, similar to the elderly. The study of children with autoimmune gastritis and their families may provide additional insights into the disease's pathogenesis and may also lead to the identification of inheritable factors influencing susceptibility. This report underlines the necessity to screen paediatric patients with organ-specific autoimmune diseases for co-existent conditions. Children with polyglandular autoimmune disease are at particularly high risk.
自身免疫性胃炎的特征是胃黏膜下层淋巴细胞浸润，伴有壁细胞和主细胞丧失以及胃酸缺乏。通常，胃炎在临床上表现为钴胺素缺乏伴巨幼细胞贫血，该病一般被描述为一种老年疾病。在此，我们报告两例青春期前儿童患自身免疫性胃炎的病例。一名儿童患自身免疫性胃炎是作为Ⅱ型多腺体自身免疫病（PGAⅡ型）家族性多腺体自身免疫病的一部分，另一名儿童则是作为典型的“甲状腺 - 胃综合征”的一部分，后者可能由情感创伤引发。两名儿童的小肠活检结果均正常，但肠道通透性异常，随后恢复正常。这些患者是迄今为止报告的最年轻病例。与老年人相似，两名儿童的免疫系统均靶向胃壁细胞自身抗原（ATP4A和ATP4B）。对患自身免疫性胃炎的儿童及其家族进行研究，可能会为该疾病的发病机制提供更多见解，也可能有助于识别影响易感性的遗传因素。本报告强调了对患有器官特异性自身免疫病的儿科患者筛查并存疾病的必要性。患有多腺体自身免疫病的儿童风险尤其高。
