Аутоиммунный гастрит: патогенез, современные подходы к диагностике и лечению


Ю.В. Эмбутниекс (1), И.Н. Войнован (1), С.В. Колбасников (2), Д.С. Бордин (1, 2)

1) ГБУЗ «Московский клинический научно-практический центр им. А.С. Логинова» ДЗМ, Москва; 2) ГБОУ ВПО «Тверской ГМУ» Минздрава России, Тверь
Аутоиммунный гастрит (АИГ) – заболевание, характеризующееся прогрессирующей атрофией слизистой оболочки тела желудка с развитием дефицита железа или B12-дефицитной (пернициозной) анемии. При АИГ в крови выявляются циркулирующие антитела к париетальным клеткам и внутреннему фактору Касла. Рассматриваются патогенез и симптоматика АИГ, представлены принципы его диагностики, обсуждается взаимосвязь АИГ с другими аутоиммунными заболеваниями, сахарным диабетом и инфекцией Helicobacter pylori. Патогенетической терапии АИГ не разработано. Симптоматическое лечение зависит от клинических проявлений и результатов лабораторных исследований. Подчеркивается, что проведение эрадикации H. pylori у пациентов с АИГ – обязательное условие терапии этого заболевания.

Литература


1. Toh B.H. Diagnosis and classification of autoimmune gastritis. Autoimmun. Rev. 2014;13(4–5):459–62.

2. Mclntyre O.R., Sullivan L.W., Jefries G.H., Silver R.H. Pernicious anemia in childhoot. New. Eng. J. Med. 1965;272:981.

3. Strickland R.G., MacKey J.R. A reappraise of the nature and significance of chronic athrophic gastritis. Dig. Dis. Sci. 1973;18:426–40.

4. Miceli E., Lenti M.V,. Padula D., Luinetti O., Vattiato C., Monti C.M., et al. Common features of patients with autoimmune atrophic gastritis. Clin. Gastroenterol. Hepatol. 2012;10:812–14.

5. Cavalcoli F., Zilli A., Conte D., Massironi S. Micronutrient deficiencies in patients with chronic atrophic autoimmune gastritis: A review World J Gastroenterol. 2017;23(4):563–72.

6. Andres E., Serraj K. Optimal management of pernicious anemia. J. Blood Med. 2012;3:97–103.

7. Carmel R. Prevalence of undiagnosed pernicious anemia in the elderly. Arch. Intern. Med. 1996;156:1097–100.

8. Wun Chan J.C., Yu Liu H.S., Sang Kho B.C., Yin Sim J.P., Hang Lau T.K., Luk Y.W., Chu R.W., Fung Cheung F.M., Tat Choi F.P., Kwan Ma E.S.. Pernicious anemia in Chinese: a study of 181 patients in a Hong Kong hospital. Medicine (Baltimore). 2006;85:129–38.

9. Malfertheiner P., Megraud F., O’Morain C.A., et al. Management of Helicobacter pylori infection Maastricht IV/ Florence Consensus Report. Gut. 2012;61:646–64.

10. Бордин Д.С., Машарова А.А., Хомерики С.Г. Хронический гастрит: современный взгляд на старую проблему. Экспериментальная и клиническая гастроэнтерология 2012;5:99–106.

11. Kaptan K., Beyan C., Ural A.U., Cetin T., Avcu F., Gülşen M., Finci R., Yalçín A. Helicobacter pylori-is it a novel causative agent in Vitamin B12 deficiency? Arch. Intern. Med. 2000;160:1349–53.

12. Dickey W., Kenny B.D., McMillan S.A., Porter K.G., McConnell J.B. Gastric as well as duodenal biopsies may be useful in the investigation of iron deficiency anaemia. Scand. J. Gastroenterol. 1997;32(5):469–72.

13. Hershko C., Hoffbrand A.V., Keret D., et al. Role of autoimmune gastritis, Helicobacter pylori and celiac disease in refractory or unexplained iron deficiency anemia. Haematologica. 2005;90(5):585–95.

14. Kaye P.V., et al. The clinical utility and diagnostic yield of routine gastric biopsies in the investigation of iron deficiency anemia: a case-control study. Am. J. Gastroenterol. 2008;103(11):2883–89.

15. Kulnigg-Dabsch S. Autoimmune gastritis. Wien Med. Wochenschr. 2016;166(13–14):424–30.

16. Silveira P.A., Wilson W.E., Esteban L.M., Jordan M.A., Hawke C.G., van Driel I.R., Baxter A.G. Identification of the Gasa3 and Gasa4 autoimmune gastritis susceptibility genes using congenic mice and partitioned, segregative and interaction analyses. Immunogenetics. 2001;53(9):741–50.

17. Park J.Y., Lam-Himlin D., Vemulapalli R. Review of autoimmune metaplastic atrophic gastritis. Gastrointest. Endosc. 2013;77:284–92.

18. Zhang Y., Weck M.N., Schöttker B., Rothenbacher D., Brenner H. Gastric parietal cell antibodies, Helicobacter pylori infection, and chronic atrophic gastritis: evidence from a large population-based study in Germany. Cancer Epidemiol. Biomarkers Prev. 2013;22:821–26.

19. Lam-Tse W.K., Batstra M.R., Koeleman B.P., et al. The association between autoimmune thyroiditis, autoimmune gastritis and type 1 diabetes. Pediatr. Endocrinol. Rev. 2003;1(1):22–37.

20. Amerio P., Tracanna M., De Remigis P., Betterle C., Vianale L., Marra M.E., Di Rollo D., Capizzi R., Feliciani C., Tulli A. Vitiligo associated with other autoimmune diseases: polyglandular autoimmune syndrome types 3B+C and 4. Clin. Exp. Dermatol. 2006;31:746–49.

21. Betterle C., Zanchetta R. Update on autoimmune polyendocrine syndromes (APS) Acta Biomed. 2003;74:9–33.

22. Massironi S., Cavalcoli F., Rossi R.E., Conte D., Spampatti M.P., Ciafardini C., Verga U., Beck-Peccoz P., Peracchi M. Chronic autoimmune atrophic gastritis associated with primary hyperparathyroidism: a transversal prospective study. Eur. J. Endocrinol. 2013;168:755–61.

23. Gołkowski F., Szybiński Z., Rachtan J., Sokołowski A., Buziak-Bereza M., Trofimiuk M., et al. Iodine prophylaxis – the protective factor against stomach cancer in iodine deficient areas. Eur. J. Nutr. 2007;46:251.

24. Portulano C., Paroder-Belenitsky M., Carrasco N. The Na+/I- symporter (NIS): mechanism and medical impact. Endocr. Rev. 2014;35:106–49.

25. Cellini M., Giulia Santaguida M., Virili C., Capriello S., Brusca N., Gargano L, Centanni M. Hashimoto’s Thyroiditis and Autoimmune Gastritis Front Endocrinol (Lausanne). 2017;8:92.

26. Tozzoli R., Kodermaz G., Perosa A.R., Tampoia M., Zucano A., Antico A., Bizzaro N. Autoantibodies to parietal cells as predictors of atrophic body gastritis: a five-year prospective study in patients with autoimmune thyroid diseases. Autoimmun. Rev. 2010;10:80–83.

27. Sibilla R., Santaguida M.G., Virili C., Gargano L., Nardo S., Della Guardia M., Viceconti N., Franchi A., Centanni M. Chronic unexplained anaemia in isolated autoimmune thyroid disease or associated with autoimmune related disorders. Clin Endocrinol (Oxf). 2008;68(4):640–45.

28. de Block C.E.M., De Leeuw I.H., Van Gaal L.F. Autoimmune Gastritis in Type 1 Diabetes: A Clinically Oriented Review. J. Clin. Endocrinol. Metab. 2008;93(2):363–71.

29. Pan X.F., Gu J.Q., Shan Z.Y. Type 1 Diabetic Populations Have an Increased Prevalence of Parietal Cell Antibody: A Systematic Review and Meta-Analysis. 2015;94(38):e1440.

30. Veijola L.I., Oksanen A.M., Sipponen P.I., Rautelin H.I. Association of autoimmune type atrophic corpus gastritis with Helicobacter pylori infection. World J. Gastroenterol. 2010;16(1):83–8.

31. Lauwers G.Y. Defining the pathologic diagnosis of metaplasia, atrophy, dysplasia, and gastric adenocarcinoma. J Clin Gastroenterol. 2003;36:S37–S43; discussion S61–S62.

32. D’Elios M.M., Amedei A., Azzurri A., Benagiano M., Del Prete G., Bergman M.P., Vandenbroucke-Grauls C.M., Appelmelk B.J. Molecular specificity and functional properties of autoreactive T-cell response in human gastric autoimmunity. Int. Rev. Immunol. 2005;24:111–22.

33. Faller G., Steininger H., Eck M., Hensen J., Hann E.G., Kirchner T. Anti-gastric autoantibodies in Helicobacter pylori gastritis: prevalence, in-situ binding sites and clues for clinical relevance. Virchows Arch. 1996;427(5):483–86.

34. Minalyan A., Benhammou J.N., Artashesyan A. Lewis M.S., Pisegna J.R. Autoimmune atrophic gastritis: current perspectives Clin Exp Gastroenterol. 2017;10:19–27.

35. Gonçalves C., Oliveira M.E., Palha A.M., Ferrão A., Morais A., Lopes A.I. Autoimmune gastritis presenting as iron deficiency anemia in childhood. World J. Gastroenterol. 2014;20(42):15780–786.

36. Tefferi A., Pruthi R.K. The biochemical basis of cobalamin deficiency. Mayo Clin. Proceed. 1994;69(2):181–86.

37. Melhem A., Desai A., Hofmann M.A. Acute myocardial infarction and pulmonary embolism in a young man with pernicious anemia-induced severe hyperhomocysteinemia. Thromb J. 2009;7(1):1–5.

38. Shamkani W.A., Jafar N.S., Narayanan S.R., Rajappan A.K. Acute myocardial infarction in a young lady due to vitamin B12 deficiency induced hyperhomocysteinemia. Heart Views. 2015;16(1):25–9.

39. Metz J. Cobalamin deficiency and the pathogenesis of nervous system disease. Ann. Rev. Nutr. 1992;12:59–79.

40. Ralapanawa D.M., Jayawickreme K.P., Ekanayake E.M., Jayalath W.A. B(12) deficiency with neurological manifestations in the absence of anaemia. BMC Res. Notes. 2015;8:458.

41. Vasconcelos O.M., Poehm E.H., McCarter R.J., Campbell W.W., Quezado Z.M.N. Potential outcome factors in subacute combined degeneration: review of observational studies. J. Gen. Intern. Med. 2006;21(10):1063–68.

42. Saperstein D.S., Barohn R.J. Peripheral neuropathy due to cobalamin deficiency. Curr. Treat. Options. Neurol. 2002;4(3):197–201.

43. Douaud G., Refsum H., de Jager C.A., et al. Preventing Alzheimer’s disease-related gray matter atrophy by B-vitamin treatment. Proc. Natl. Acad. Sci. USA. 2013;110(23):9523–28.

44. Lahner E., Annibale B. Pernicious anemia: new insights from a gastroenterological point of view. World J. Gastroenterol. 2009;15(41):5121–28.

45. Zhu J.C., Wang Y.F., Sheng J., Chen F.X., Tang G.Y. Atrophic glossitis is attributed to cobalamin deficiency. Shanghai J. Stomatol. 2013;22(1):58–62.

46. Carabotti M., Lahner E., Esposito G., Sacchi M.C., Severi C., Annibale B. Upper gastrointestinal symptoms in autoimmune gastritis: A cross-sectional study. Medicine (Baltimore). 2017;96(1):5784.

47. Coati I., Fassan M, Farinati F., Graham D.Y., Genta R.M., Rugge M. Autoimmune gastritis: Pathologist’s viewpoint World J Gastroenterol. 2015;21(42):12179–189.

48. Wong H.H., Chu P. Immunohistochemical features of the gastrointestinal tract tumors. J. Gastrointest. Oncol. 2012;3(3):262–84.

49. Torbenson M., Abraham S.C., Boitnott J., Yardley J.H., Wu T.T. Autoimmune gastritis: distinct histological and immunohistochemical findings before complete loss of oxyntic glands. Mod. Pathol. 2002;15:102–9.

50. Rugge M., Fassan M., Pizzi M., Pennelli G., Nitti D., Farinati F. Operative Link for Gastritis Assessment gastritis staging incorporates intestinal metaplasia subtyping. Hum. Pathol. 2011;42:1539–44.

51. Burkitt M.D., Pritchard D.M. Review article: pathogenesis and management of gastric carcinoid tumours. Aliment Pharmacol. Ther. 2006;24(9):1305–320.

52. Zhou K., Ho W. Gastric carcinoids: classification and Diagnosis. In: Pisegna R.J., editor. Management of Pancreatic Neuroendocrine Tumors. New York, NY: Springer New York, 2015. P. 83–93.

53. Li T.-T., Qiu F., Qian Z.R., Wan J., Qi X.-K., Wu B.-Y. Classification, clinicopathologic features and treatment of gastric neuroendocrine tumors. World J. Gastroenterol. 2014;20(1):118–25.

54. Minalyan A., Benhammou J.N., Artashesyan A., Lewis M., Pisegna J.R. Autoimmune atrophic gastritis: current perspectives. Clin. Exp. Gastroenterol. 2017;10:19–27.

55. Faller G., Winter M., Steininger H., et al. Decrease of antigastric autoantibodies in Helicobacter pylorigastritis after cure of infection. Pathol. Res. Pract. 1999;195(4):243–46.


Об авторах / Для корреспонденции


Автор для связи: Ю.В. Эмбутниекс – д.м.н., зав. отделением патологии верхних отделов пищеварительного тракта ГБУЗ МКНЦ им. А.С. Логинова ДЗМ, Москва; e-mail: y.embutnieks@mknc.ru


Похожие статьи


Бионика Медиа