Castoro C, Le Moli R, Arpi M L, Tavarelli M, Sapuppo G, Frittitta L, Squatrito S, Pellegriti G
Department of Clinical and Experimental Medicine, University of Catania, Catania, Italy.
Endocrinology, Garibaldi-Nesima Hospital, Via Palermo n. 636, 95126, Catania, Italy.
J Endocrinol Invest. 2016 Jul;39(7):779-84. doi: 10.1007/s40618-016-0445-5. Epub 2016 Feb 29.
Autoimmune polyendocrine syndromes (APS) type III are characterized by the association of autoimmune thyroid disease (ATD) with other autoimmune diseases such as diabetes, alopecia, pernicious anemia, vitiligo and chronic atrophic gastritis. A strong association between ATD and atrophic gastritis (AG) has been demonstrated. Moreover 10 % of patients affected by AG have a predisposition to develop gastric carcinoid and adenocarcinoma as a result of chronic hypergastrinemia caused by achlorhydria and subsequent ELC cells neoplastic transformation.
The aim of the study is to evaluate, in a consecutive series of patients followed for ATD in our outpatients clinic, the prevalence of AG. In the period 2004-2014, 242 patients with ATD underwent a screening performing APCA, Vitamin B12, ferritin, iron, and hemoglobin and red cells count measurements with subsequent gastroscopy in case of APCA positivity.
We found 57/242 (23.5 %) patients with APCA positivity. Of these patients 33/57 (57.8 %), 31 F and 2 M, were affected by Graves disease; 24/57 (42.1 %) 21 F and 3 M by Hashimoto thyroiditis; 10/57 (17.5 %) presented with anemia, 14/57 (24.5 %) with vitamin B12 deficiency, 9/57 (15.7 %) with iron deficiency. In 2/57 a gastric carcinoid was found.
Our data confirm the high association rate of AG in ATD which frequently is not an isolated disease but configure the picture of APS type III and need to be followed accordingly. An early diagnosis may be useful for diagnosis of gastric carcinoids and to explain and treat a gastric related L-thyroxine malabsorption and presence of chronic unexplained anemia.
Ⅲ型自身免疫性多内分泌腺综合征（APS）的特征是自身免疫性甲状腺疾病（ATD）与其他自身免疫性疾病相关联，如糖尿病、脱发、恶性贫血、白癜风和慢性萎缩性胃炎。已证实ATD与萎缩性胃炎（AG）之间存在密切关联。此外，10%的AG患者由于胃酸缺乏导致的慢性高胃泌素血症及随后的肠嗜铬样（ELC）细胞肿瘤转化，易发生胃类癌和腺癌。
本研究的目的是评估在我们门诊连续随访的ATD患者中AG的患病率。在2004年至2014年期间，242例ATD患者接受了抗胃壁细胞抗体（APCA）、维生素B12、铁蛋白、铁以及血红蛋白和红细胞计数的筛查，若APCA阳性则随后进行胃镜检查。
我们发现57/242（23.5%）例患者APCA阳性。在这些患者中，33/57（57.8%），31例女性和2例男性，患有格雷夫斯病；24/57（42.1%），21例女性和3例男性，患有桥本甲状腺炎；10/57（17.5%）出现贫血，14/57（24.5%）存在维生素B12缺乏，9/57（15.7%）缺铁。在2/57例患者中发现了胃类癌。
我们的数据证实了AG在ATD中的高关联率，ATD通常不是一种孤立的疾病，而是构成了Ⅲ型APS的情况，需要相应地进行随访。早期诊断可能有助于胃类癌的诊断，并解释和治疗与胃相关的左甲状腺素吸收不良以及慢性不明原因贫血的存在。
