| BackgroundAutoimmune gastritis（AIG）is also known as type A gastritis.In 1973,Srickland and Mackay divided chronic atrophic gastritis into type A and type B according to the lesion location[1].AIG is the result of a complex interaction between host-related factors（genetic susceptibility）and environmental factors（endogenous and exogenous）,resulting in immune disorders including sensitization of T lymphocytes[2]and produced anti-parietal cell anti-bodies（PCA）and anti-intrinsic factor antibodies（AIF）,which caused the gastric body and gastric fundus diffuse atrophy,and the gastric antrum mucosa is basically normal,which may eventually develop into malignant anemia,gastric carcinoid or adenocarcinoma..It was previously believed that AIG was a disease specific to elderly women in northern Europe,but further research broke the understanding of AIG’s racial clustering[3-4].Similar to common autoimmune diseases,AIG is often accompanied by other autoimmune diseases.So far,Domestic and foreign AILD merger of AIG related reports are few,clinical diagnosis is easy to be ignored.ObjectiveThe clinical characteristics and prognosis of autoimmune gastritis（AIG）complicated with autoimmune liver disease（AILD）were analyzed to improve the understanding of AIG and AILD.MethodsThe clinical data of 9 AIG patients with AILD（experimental group）and 30 AIG patients with normal liver function（control group）diagnosed in the first affiliated hospital of zhengzhou university from 2016 to 2018 were retrospectively analyzed.Blood routine,liver function,five items of self-exemption from gastrointestinal function,four items of gastric function,and gastric biopsy pathology under endoscopy were collected and recorded for all patients,and 12 items of self-exemption from liver function,HLA-DR gene test,and liver biopsy pathology were added for the experimental group.Clinical data and prognosis of patients in the two groups were compared.Results1.There was no significant difference between the two groups in gender,age,fatigue,poor appetite,weight loss,limb numbness,upper abdominal discomfort（dull pain,abdominal distension）（P>0.05）,There were statistically significant differences in jaundice and mouth/eye drynes（P<0.05）.2.After treatment,the clinical symptoms and biochemical tests of 7 patients（7/9）in the experimental group were restored to normal,and the clinical symptoms of 2patients（2/9）were relieved,and the blood biochemical indexes were improved compared with the baseline level.In the control group,anemia was corrected in 26cases（26/30）and treatment failed in 4 cases（4/30）.There was no significant difference in the prognosis of anemia between the two groups（P=0.6069>0.05）.3.After treatment and subsequent gastroscopy,5 cases（5/7）of gastric mucosal inflammation in the hormone group were improved,and 1 case showed intestinal metaplasia reversal.In the non-hormone group,5 patients（5/32）were re-examined by gastroscopy,among which 2 patients（2/32）showed no significant change in gastric mucosal inflammation,2 patients（2/32）showed gastric hyperplastic polyp,1 patient（1/32）showed gastric mucosal laminar lymphocyte hyperplasia,and the rest were re-examined by gastroscopy.4.Patients with PBC characteristics（7/9）were more likely to have AIG than patients with AIH characteristics（5/9）,and no patients with PSC or IgG 4-sc merging AIG were found in the study.Conclusion1.Hormone therapy for AIG patients may reverse gastric mucosal atrophy and improve fatigue symptoms of AIG anemia patients,but due to the small number of samples in this study and limited follow-up time,its specific efficacy and long-term prognosis need further demonstration.2.VitB12,folic acid and iron supplement treatment can basically improve the anemia status of patients,but may not be ideal for improving the inflammation status of gastric mucosa.Considering the higher risk of gastric cancer in AIG patients,better drugs are needed to prevent the progression of the disease.3.Among patients with AILD,PBC is easier to merge AIG,and the possibility of AIH should be noted during follow-up.AIG can also occur in patients with AIH+PBC OS. |
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