第一临床医学院知识库

目的：探讨慢性萎缩性胃炎(Chronic atrophic gastritis，CAG)的临床特征，包括一般资料、临床症状、实验室检查、内镜及病理活组织检查、流行病学、诊断与治疗等，协助临床医生深化对该病的认识及诊疗水平。方法：回顾性分析兰州大学第一医院消化科2012年1月至2017年12月期间经电子胃镜及病理活检确诊为CAG患者的临床资料共计231例，根据年龄共分为三组：青年组（57例）、中年组（95例）、老年组（79例）。
结果：1.本研究231例CAG患者年龄在18~87岁之间，平均年龄58.62±19.31岁，以50-59岁为CAG发病高峰年龄段，男性患者占多数（61.47%）。2.不同年龄段CAG患者均以农村、汉族人口多见，一般无明显家族史。3.不同年龄段CAG患者在性别构成、体质指数方面存在明显差异，中青年组以男性患者多见，体质指数偏高，老年组以女性患者多见，体质指数偏低。4.不同年龄段CAG患者一般临床表现除上腹痛、恶心／呕吐多见于青年组、腹泻多见于老年组外，余无明显差异，整体上CAG常见临床症状发生率由高到低分别为餐后早饱122例（52.81%）、纳差119例（51.52%）、上腹痛119例（51.52%）、嗳气117例（50.65%）。5.不同年龄段CAG患者实验室检查异常无明显差异，整体上CAG常见实验室检查异常为Hp感染及Hb下降，发生率分别为71.43%和26.41％。6.不同年龄段CAG患者可描记胃镜下特点除糜烂多见于青年组之外，余无明显差异，整体上CAG常见胃镜下伴随病变为黏膜血管显露、黏膜颗粒或结节，发生率分别为44.16%和38.11%。７.不同年龄段CAG患者胃黏膜病理活检结果均具有明显差异，青年组以轻度、中度萎缩为主，肠化生发生率较低，以中度、轻度为主，上皮内瘤变发生率较低，以低级别为主；中年组以中度、轻度萎缩为主，肠化生发生率较低，以中度、重度为主，上皮内瘤变发生率较低，以低级别为主；老年组以中度、重度萎缩为主，肠化生发生率较低，以中度、轻度为主，上皮内瘤变发生率较低，以高级别为主。
结论：CAG是一种常见胃癌癌前疾病，男性患者多见，农村及汉族人口发病率较高，其临床表现多样且无明显特异性，常规检查、化验大都无法提供最终诊断依据，确诊依靠病理活组织检查，具体病因及发病机制有待进一步阐明，目前治疗以对症为主，随着相关基础医学研究的深入及诊疗设备的升级，CAG的诊断与治疗正朝着无创、精准、高效的方向快速发展，中医学对CAG的认知具有丰富的理论内涵，在整体辨证论治的指导下取得了较高的临床治疗效果，为临床诊治CAG提供了可靠的参考依据。                              

Objective:To investigate the clinical features of chronic atrophic gastritis (CAG),including general data,clinical symptoms,laboratory tests,endoscopic and biopsy,epidemiology,diagnosis and treatment,to assist clinicians in deepening Knowledge of the disease and the level of diagnosis and treatment.Methods:A total of 231 cases of CAG diagnosed by gastroscope and pathological biopsy between January 2012 and December 2017 in Department of Gastroenterology,,First Hospital of Lanzhou University were retrospectively analyzed.According to their age,they were divided into three groups:the young group ( 57 cases),middle-aged group (95 cases),elderly group (79 cases).

Result:1.In this study, 231 patients with CAG were aged between 18 and 87 years old, with an average age of 58.62±19.31 years old. The incidence of peak age of CAG was 50-59 years old, and male patients accounted for the majority (61.47%).2.The patients of different age groups were more common in rural and Han populations and generally had no family history.3.There are significant differences in gender composition and body mass index among patients of different age groups. The middle-aged and young people are more common in male patients and have higher body mass index. The elderly patients are more common in female patients and the body mass index is lower.4.The general clinical manifestations of patients with CAG in different age groups were higher than those in the younger group, with more abdominal pain, nausea/vomiting, and diarrhea more common in the elderly group. There was no significant difference between the two groups. Overall, the incidence of common clinical symptoms of CAG was from high to low, respectively. early fullness122 cases (52.81%), analgesia 119 cases (51.52%), abdominal pain 119 cases (51.52%), hernia 117 cases (50.65%).5.There was no significant difference in laboratory examinations between patients of different age groups. The overall abnormal laboratory examinations of CAG were Hp infection and Hb decline. The incidence rates were 71.43% and 26.41%, respectively.6.The characteristics of gastroscopy in patients with different ages can be traced by gastroscopy, except that erosion was more common in the young group than in the young group. There were no significant differences in the other groups. The common CAG common gastroscopy associated with lesions was mucosal vascular exposure, mucosal granules or nodules, with an incidence of 44.16% and 38.11%.7.The pathological biopsy results of gastric mucosa in patients with different ages of CAG were significantly different. The young group had mild to moderate atrophy. The incidence of intestinal metaplasia was lower. The incidence was moderate and mild, and the incidence of intraepithelial neoplasia was significant. Lower, mainly in low grade; middle-aged group mainly in moderate, mild atrophy, low incidence of intestinal metaplasia, moderate to severe, low incidence of intraepithelial neoplasia, with low level In the old age group, moderate and severe atrophy dominated, and the incidence of intestinal metaplasia was low, with moderate and mild predominance. The incidence of intraepithelial neoplasia was low, with high grade as the main.
Conclusion:CAG is a common precancerous disease of gastric cancer. It is more common in male patients. The incidence rate of rural and Han populations is higher. Its clinical manifestations are diverse and there is no obvious specificity. Routine examination and laboratory tests can not provide the final diagnosis basis. The diagnosis depends on pathological tissue. Examination, specific etiology and pathogenesis need to be further clarified. At present, treatment is mainly symptomatic. With the development of relevant basic medical research and the upgrading of diagnostic and treatment equipment, CAG's diagnosis and treatment are rapidly developing in a non-invasive, accurate, and efficient manner. Chinese medicine has rich theoretical connotations for CAG's cognition. Under the guidance of overall syndrome differentiation and treatment, it has achieved high clinical therapeutic effect, providing a reliable reference for clinical diagnosis and treatment of CAG.