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摘要: 慢性萎缩性胃炎属于胃癌的癌前疾病状态,是炎-癌转化的发生关口,近年来患病率呈上升且有年轻化趋势,严重威胁人类生活健康。目前慢性萎缩性胃炎的发病机制尚未明确统一,研究发现慢性萎缩性胃炎发病与幽门螺杆菌感染、自身免疫反应异常、胆汁反流和胃内非幽门螺杆菌菌群等相关。笔者查阅国内外相关文献资料,整理慢性萎缩性胃炎的相关发病机制,以供学习交流。Abstract: Chronic atrophic gastritis is a precancerous disease state of gastric cancer, which is the key to the occurrence of inflammatory-cancer transformation. In recent years, the prevalence rate is on the rise and tends to be younger, which seriously threatens human life and health. At present, the pathogenesis of chronic atrophic gastritis has not been clearly unified. Studies have found that the pathogenesis of chronic atrophic gastritis is related to helicobacter pylori infection, abnoral autoimmune reaction, bile reflux and non-helicobacter pylori flora in the stomach. The author consulted relevant literature at home and abroad to sort out the pathogenesis of chronic atrophic gastritis for learning and communication.
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[1] 李军祥, 陈誩, 吕宾, 等. 慢性萎缩性胃炎中西医结合诊疗共识意见(2017年)[J]. 中国中西医结合消化杂志, 2018, 26(2): 121-131. http://zxpw.cbpt.cnki.net/WKD2/WebPublication/paperDigest.aspx?paperID=eaf58a60-5f57-49e4-bf46-42b6728310f9
[2] Lahner E, Zagari RM, Zullo A, et al. Chronic atrophic gastritis: natural history, diagnosis and therapeutic management. A position paper by the Italian Society of Hospital Gastroenterologists and Digestive Endoscopists[AIGO], the Italian Society of Digestive Endoscopy[SIED], the Italian Society of Gastroenterology[SIGE], and the Italian Society of Internal Medicine[SIMI[J]. Dig Liver Dis, 2019, 51(12): 1621-1632. doi: 10.1016/j.dld.2019.09.016
[3] 王亚杰, 国嵩, 杨洋, 等. 慢性萎缩性胃炎的流行病学及其危险因素分析[J]. 中国中西医结合消化杂志, 2019, 27(11): 874-878. http://zxpw.cbpt.cnki.net/WKD2/WebPublication/paperDigest.aspx?paperID=9e6172e4-b404-4ac1-9305-869c10dbbcc9
[4] Song H, Held M, Sandin S, et al. Increase in the prevalence of atrophic gastritis among adults age 35 to 44 years old in northern Sweden between 1990 and 2009[J]. Clin Gastroenterol Hepatol, 2015, 13(9): 1592-1600.e1. doi: 10.1016/j.cgh.2015.04.001
[5] Lahner E, Conti L, Annibale B, et al. Current Perspectives in Atrophic Gastritis[J]. Curr Gastroenterol Rep, 2020, 22(8): 38. doi: 10.1007/s11894-020-00775-1
[6] Cavalcoli F, Zilli A, Conte D, et al. Micronutrient deficiencies in patients with chronic atrophic autoimmune gastritis: a review[J]. World J Gastroenterol, 2017, 23(4): 563-572. doi: 10.3748/wjg.v23.i4.563
[7] Amin DR, Awais DM, Bashir DR. A review: clinical manifestations of chronic atrophic gastritis[J]. Acta Biomed, 2018, 89(8-S): 88-92.
[8] Yang GT, Zhao HY, Kong Y, et al. Correlation between serum vitamin B12 level and peripheral neuropathy in atrophic gastritis[J]. World J Gastroenterol, 2018, 24(12): 1343-1352. doi: 10.3748/wjg.v24.i12.1343
[9] Rodriguez-Castro KI, Franceschi M, Miraglia C, et al. Autoimmune diseases in autoimmune atrophic gastritis[J]. Acta Biomed, 2018, 89(8-S): 100-103.
[10] Hu Y, Liu S, Lv B. The significance of OLGA and OLGIM staging systems in the risk assessment of gastric cancer: a systematic review and meta-analysis[J]. Gastric Cancer, 2018, 21(4): 579-587. doi: 10.1007/s10120-018-0812-3
[11] Pimentel-Nunes P, Libanio D, Marcos-Pinto R, et al. Management of epithelial precancerous conditions and lesions in the stomach(MAPS): European Society of Gastrointestinal Endoscopy(ESGE), European Helicobacter and Microbiota Study Group(EHMSG), European Society of Pathology(ESP), and Sociedade Portuguesa de Endoscopia Digestiva(SPED)guideline update 2019[J]. Endoscopy, 2019, 51(4): 365-388. doi: 10.1055/a-0859-1883
[12] Correa P. The biological model of gastric carcinogenesis[J]. IARC Sci Publ, 2004, 157: 301-310.
[13] Lahner E, Carabotti M, Annibale B. Treatment of Helicobacter pylori infection in atrophic gastritis[J]. World J Gastroenterol, 2018, 24(22): 2373-2380. doi: 10.3748/wjg.v24.i22.2373
[14] Denic M, Touati E, De Reuse H. Review: pathogenesis of Helicobacter pylori infection[J]. Helicobacter, 2020, 25(Suppl 1): e12736.
[15] Adamu MA, Weck MN, Gao L, et al. Incidence of chronic atrophic gastritis: systematic review and meta-analysis of follow-up studies[J]. Eur J Epidemiol, 2010, 25(7): 439-448. doi: 10.1007/s10654-010-9482-0
[16] Holleczek B, Schöttker B, Brenner H. Helicobacter pylori infection, chronic atrophic gastritis and risk of stomach and esophagus cancer: results from the prospective population-based ESTHER cohort study[J]. Int J Cancer, 2020, 146(10): 2773-2783. doi: 10.1002/ijc.32610
[17] Backert S, Clyne M. Pathogenesis of Helicobacter pylori infection[J]. Helicobacter, 2011, 16: 19-25. doi: 10.1111/j.1523-5378.2011.00876.x
[18] de Brito BB, da Silva FAF, Soares AS, et al. Pathogenesis and clinical management of Helicobacter pylori gastric infection[J]. World J Gastroenterol, 2019, 25(37): 5578-5589. doi: 10.3748/wjg.v25.i37.5578
[19] Chauhan N, Tay ACY, Marshall BJ, et al. Helicobacter pylori VacA, a distinct toxin exerts diverse functionalities in numerous cells: an overview[J]. Helicobacter, 2019, 24(1): e12544. doi: 10.1111/hel.12544
[20] Ansari S, Yamaoka Y. Role of vacuolating cytotoxin A in Helicobacter pylori infection and its impact on gastric pathogenesis[J]. Expert Rev Anti Infect Ther, 2020, 18(10): 987-996. doi: 10.1080/14787210.2020.1782739
[21] Cui GL, Yuan AP, Li ZF. Occurrences and phenotypes of RIPK3-positive gastric cells in Helicobacter pylori infected gastritis and atrophic lesions[J]. Dig Liver Dis, 2022, 54(10): 1342-1349. doi: 10.1016/j.dld.2022.04.013
[22] Pachathundikandi SK, Blaser N, Bruns H, et al. Helicobacter pylori avoids the critical activation of NLRP3 inflammasome-mediated production of oncogenic mature IL-1β in human immune cells[J]. Cancers, 2020, 12(4): 803. doi: 10.3390/cancers12040803
[23] Nehme F, Rowe K, Palko W, et al. Autoimmune metaplastic atrophic gastritis and association with neuroendocrine tumors of the stomach[J]. Clin J Gastroenterol, 2020, 13(3): 299-307. doi: 10.1007/s12328-019-01074-7
[24] Rustgi SD, Bijlani P, Shah SC. Autoimmune gastritis, with or without pernicious anemia: epidemiology, risk factors, and clinical management[J]. Therap Adv Gastroenterol, 2021, 14: 17562848211038771.
[25] Lenti MV, Rugge M, Lahner E, et al. Autoimmune gastritis[J]. Nat Rev Dis Primers, 2020, 6(1): 56. doi: 10.1038/s41572-020-0187-8
[26] Hall S, Appelman H. Autoimmune gastritis[J]. Arch Pathol Lab Med, 2019, 143(11): 1327-1331. doi: 10.5858/arpa.2019-0345-RA
[27] Mahmud N, Stashek K, Katona BW, et al. The incidence of neoplasia in patients with autoimmune metaplastic atrophic gastritis: a renewed call for surveillance[J]. Ann Gastroenterol, 2019, 32(1): 67-72.
[28] Massironi S, Zilli A, Elvevi A, et al. The changing face of chronic autoimmune atrophic gastritis: an updated comprehensive perspective[J]. Autoimmun Rev, 2019, 18(3): 215-222. doi: 10.1016/j.autrev.2018.08.011
[29] Coati I, Fassan M, Farinati F, et al. Autoimmune gastritis: pathologist's viewpoint[J]. World J Gastroenterol, 2015, 21(42): 12179-12189. doi: 10.3748/wjg.v21.i42.12179
[30] Chmiela M, Gonciarz W. Molecular mimicry in Helicobacter pylori infections[J]. World J Gastroenterol, 2017, 23(22): 3964-3977. doi: 10.3748/wjg.v23.i22.3964
[31] de Jong H, Wösten MMSM, Wennekes T. Sweet impersonators: molecular mimicry of host glycans by bacteria[J]. Glycobiology, 2022, 32(1): 11-22. doi: 10.1093/glycob/cwab104
[32] Rojas M, Restrepo-Jiménez P, Monsalve DM, et al. Molecular mimicry and autoimmunity[J]. J Autoimmun, 2018, 95: 100-123. doi: 10.1016/j.jaut.2018.10.012
[33] Amedei A, Bergman MP, Appelmelk BJ, et al. Molecular mimicry between Helicobacter pylori antigens and H+, K+ adenosine triphosphatase in human gastric autoimmunity[J]. J Exp Med, 2003, 198(8): 1147-1156. doi: 10.1084/jem.20030530
[34] Presotto F, Sabini B, Cecchetto A, et al. Helicobacter pylori infection and gastric autoimmune diseases: is there a link?[J]. Helicobacter, 2003, 8(6): 578-584. doi: 10.1111/j.1523-5378.2003.00187.x
[35] Veijola LI, Oksanen AM, Sipponen PI, et al. Association of autoimmune type atrophic corpus gastritis withHelicobacter pyloriinfection[J]. World J Gastroenterol, 2010, 16(1): 83-88.
[36] Zhang Y, Weck MN, Schottker B, et al. Gastric parietal cell antibodies, Helicobacter pylori infection, and chronic atrophic gastritis: evidence from a large population-based study in Germany[J]. Cancer Epidemiol Biomarkers Prev, 2013, 22(5): 821-826. doi: 10.1158/1055-9965.EPI-12-1343
[37] De Re V, Repetto O, De Zorzi M, et al. Polymorphism in toll-like receptors and Helicobacter pylori motility in autoimmune atrophic gastritis and gastric cancer[J]. Cancers(Basel), 2019, 11(5): 648.
[38] Youssefi M, Tafaghodi M, Farsiani H, et al. Helicobacter pylori infection and autoimmune diseases; Is there an association with systemic lupus erythematosus, rheumatoid arthritis, autoimmune atrophy gastritis and autoimmune pancreatitis? A systematic review and meta-analysis study[J]. J Microbiol Immunol Infect, 2021, 54(3): 359-369. doi: 10.1016/j.jmii.2020.08.011
[39] 刘凤斌, 李培武, 潘静琳, 等. 岭南地区慢性萎缩性胃炎中医诊疗专家共识[J]. 中国研究型医院, 2022, 9(1): 2-8. https://www.cnki.com.cn/Article/CJFDTOTAL-YJXU202201002.htm
[40] 张云桐, 谢琪. 慢性萎缩性胃炎癌前病变病因病机研究进展[J]. 世界最新医学信息文摘, 2019, 19(8): 130-131. https://www.cnki.com.cn/Article/CJFDTOTAL-WMIA201908060.htm
[41] Di Ciaula A, Garruti G, Lunardi Baccetto R, et al. Bile acid physiology[J]. Ann Hepatol, 2017, 16(Suppl1): s4-s14.
[42] Chen SL, Mo JZ, Cao ZJ, et al. Effects of bile reflux on gastric mucosal lesions in patients with dyspepsia or chronic gastritis[J]. World J Gastroenterol, 2005, 11(18): 2834-2837. doi: 10.3748/wjg.v11.i18.2834
[43] Shi YY, Wei Y, Zhang T, et al. Deoxycholic acid could induce apoptosis and trigger gastric carcinogenesis on gastric epithelial cells by quantitative proteomic analysis[J]. Gastroenterol Res Pract, 2016, 2016: 9638963.
[44] Hagen SJ. Mucosal defense: gastroduodenal injury and repair mechanisms[J]. Curr Opin Gastroenterol, 2021, 37(6): 609-614. doi: 10.1097/MOG.0000000000000775
[45] Hagen SJ. Gastroduodenal injury and repair: novel targets for therapeutic intervention[J]. Curr Opin Gastroenterol, 2022, 38(6): 607-612. doi: 10.1097/MOG.0000000000000883
[46] 司小北, 石岩岩, 丁士刚. 胃黏膜组织解痉多肽表达化生的研究进展[J]. 临床荟萃, 2022, 37(1): 77-80. https://www.cnki.com.cn/Article/CJFDTOTAL-LCFC202201015.htm
[47] Li D, Zhang J, Yao WZ, et al. The relationship between gastric cancer, its precancerous lesions and bile reflux: a retrospective study[J]. J Dig Dis, 2020, 21(4): 222-229. doi: 10.1111/1751-2980.12858
[48] Zhang LY, Zhang J, Li D, et al. Bile reflux is an independent risk factor for precancerous gastric lesions and gastric cancer: an observational cross-sectional study[J]. J Dig Dis, 2021, 22(5): 282-290. doi: 10.1111/1751-2980.12986
[49] Wang ML, Lou EZ, Xue ZF. The role of bile acid in intestinal metaplasia[J]. Front Physiol, 2023, 14: 1115250. doi: 10.3389/fphys.2023.1115250
[50] Yu JH, Zheng JB, Qi J, et al. Bile acids promote gastric intestinal metaplasia by upregulating CDX2 and MUC2expression via the FXR/NF-κB signalling pathway[J]. Int J Oncol, 2019, 54(3): 879-892.
[51] Yuan T, Ni Z, Han C, et al. SOX2 interferes with the function of CDX2 in bile acid-induced gastric intestinal metaplasia[J]. Cancer Cell Int, 2019, 19: 24. doi: 10.1186/s12935-019-0739-8
[52] Huang G, Wang S, Wang JX, et al. Bile reflux alters the profile of the gastric mucosa microbiota[J]. Front Cell Infect Microbiol, 2022, 12: 940687. doi: 10.3389/fcimb.2022.940687
[53] Jin DC, Huang KT, Xu M, et al. Deoxycholic acid induces gastric intestinal metaplasia by activating STAT3 signaling and disturbing gastric bile acids metabolism and microbiota[J]. Gut Microbes, 2022, 14(1): 2120744. doi: 10.1080/19490976.2022.2120744
[54] 何晓曼, 王玉刚. 胃内非Hp菌群与胃癌和癌前状态演进的研究进展[J]. 胃肠病学, 2020, 25(9): 568-571. https://www.cnki.com.cn/Article/CJFDTOTAL-WIEC202009011.htm
[55] Sung J, Kim N, Kim J, et al. Comparison of gastric microbiota between gastric juice and mucosa by next generation sequencing method[J]. J Cancer Prev, 2016, 21(1): 60-65. doi: 10.15430/JCP.2016.21.1.60
[56] Parsons BN, Ijaz UZ, D'Amore R, et al. Comparison of the human gastric microbiota in hypochlorhydric states arising as a result of Helicobacter pylori-induced atrophic gastritis, autoimmune atrophic gastritis and proton pump inhibitor use[J]. PLoS Pathog, 2017, 13(11): e1006653. doi: 10.1371/journal.ppat.1006653
[57] Gantuya B, El Serag HB, Matsumoto T, et al. Gastric mucosal microbiota in a Mongolian population with gastric cancer and precursor conditions[J]. Aliment Pharmacol Ther, 2020, 51(8): 770-780. doi: 10.1111/apt.15675
[58] Shin CM, Kim N, Park JH, et al. Changes in gastric corpus microbiota with age and after Helicobacter pylori eradication: a long-term follow-up study[J]. Front Microbiol, 2020, 11: 621879.
[59] Shi YC, Cai ST, Tian YP, et al. Effects of proton pump inhibitors on the gastrointestinal microbiota in gastroesophageal reflux disease[J]. Genomics Proteomics Bioinformatics, 2019, 17(1): 52-63. doi: 10.1016/j.gpb.2018.12.004
[60] Lin CY, Cheng HT, Kuo CJ, et al. Proton pump inhibitor-induced gut dysbiosis increases mortality rates for patients withClostridioidesdifficile infection[J]. Microbiol Spectr, 2022, 10(4): e0048622. doi: 10.1128/spectrum.00486-22
[61] Peng XH, Zhou LY, Gong YN, et al. Non-pylori helicobacters(NHPHs) induce shifts in gastric microbiota in Helicobacter pylori-infected patients[J]. Front Microbiol, 2017, 8: 1038. doi: 10.3389/fmicb.2017.01038
[62] Sung JJY, Coker OO, Chu E, et al. Gastric microbes associated with gastric inflammation, atrophy and intestinal metaplasia 1 year after Helicobacter pylori eradication[J]. Gut, 2020, 69(9): 1572-1580.
[63] Liu JZ, Xue Y, Zhou LY. Detection of gastritis-associated pathogens by culturing of gastric juice and mucosa[J]. Int J Clin Exp Pathol, 2018, 11(4): 2214-2220.
[64] Liu DH, Zhang RT, Chen S, et al. Analysis of gastric microbiome reveals three distinctive microbial communities associated with the occurrence of gastric cancer[J]. BMC Microbiol, 2022, 22(1): 184.
[65] Zi ML, Zhang YQ, Hu C, et al. A literature review on the potential clinical implications of streptococci in gastric cancer[J]. Front Microbiol, 2022, 13: 1010465.
[66] Gunathilake M, Lee J, Choi IJ, et al. Association between bacteria other than Helicobacter pylori and the risk of gastric cancer[J]. Helicobacter, 2021, 26(5): e12836.
[67] Ling ZX, Shao L, Liu X, et al. Regulatory T cells and plasmacytoid dendritic cells within the tumor microenvironment in gastric cancer are correlated with gastric microbiota dysbiosis: a preliminary study[J]. Front Immunol, 2019, 10: 533.
[68] De Witte C, Schulz C, Smet A, et al. Other helicobacters and gastric microbiota[J]. Helicobacter, 2016, 21: 62-68.
[69] Wu HZ, Liang GR, Kong MJ, et al. The status and risk factors for anxiety/depression in patients with atrophic chronic gastritis: a cross-sectional study[J]. Ann Palliat Med, 2022, 11(10): 3147-3159.
[70] 方霜霜. 慢性萎缩性胃炎患者焦虑抑郁状态、中医证候及OLGA/OLGIM相关性研究[D]. 北京: 北京中医药大学, 2021.
[71] Shah SC, Piazuelo MB, Kuipers EJ, et al. AGA clinical practice update on the diagnosis and management of atrophic gastritis: expert review[J]. Gastroenterology, 2021, 161(4): 1325-1332.e7.
[72] 赵霞, 徐薇薇, 刘益萌, 等. 中国大陆地区幽门螺杆菌对常用抗生素耐药性的临床分析[J]. 基础医学与临床, 2022, 42(7): 1077-1082. https://www.cnki.com.cn/Article/CJFDTOTAL-JCYL202207012.htm
[73] Lenti MV, Miceli E, Cococcia S, et al. Determinants of diagnostic delay in autoimmune atrophic gastritis[J]. Aliment Pharmacol Ther, 2019, 50(2): 167-175.
[74] Lenti MV, Miceli E, Padula D, et al. The challenging diagnosis of autoimmune atrophic gastritis[J]. Scand J Gastroenterol, 2017, 52(4): 471-472.
[75] Castellana C, Pecere S, Furnari M, et al. Side effects of long-term use of proton pump inhibitors: practical considerations[J]. Pol Arch Intern Med, 2021, 131(6): 541-549.
[76] Oncel S, Basson MD. Gut homeostasis, injury, and healing: new therapeutic targets[J]. World J Gastroenterol, 2022, 28(17): 1725-1750.
[77] Li WS, Lin SC, Chu CH, et al. The gastroprotective effect of naringenin against ethanol-induced gastric ulcers in mice through inhibiting oxidative and inflammatory responses[J]. Int J Mol Sci, 2021, 22(21): 11985.
[78] Lin KW, Deng T, Qu HJ, et al. Gastric protective effect of Alpinia officinarum flavonoids: mediating TLR4/NF-κB and TRPV1 signalling pathways and gastric mucosal healing[J]. Pharm Biol, 2023, 61(1): 50-60.
[79] Qu HJ, Lin KW, Li XL, et al. Chemical constituents and anti-gastric ulcer activity of essential oils of Alpinia officinarum(Zingiberaceae), Cyperus rotundus(Cyperaceae), and their herbal pair[J]. Chem Biodivers, 2021, 18(10): e2100214.
[80] 余云进, 谢宇锋, 杨锦兰, 等. 基于"热证可灸"理论研究艾灸对胃热证大鼠肠道微生态的影响[J]. 中国中医基础医学杂志, 2020, 26(10): 1470-1474. https://www.cnki.com.cn/Article/CJFDTOTAL-ZYJC202010020.htm
[81] 周巍, 杨青, 舒文娜, 等. 艾灸与针刺对慢性萎缩性胃炎大鼠胃黏膜细胞凋亡及NF-κB、Bcl-2基因表达的影响[J]. 针刺研究, 2021, 46(4): 284-288. https://www.cnki.com.cn/Article/CJFDTOTAL-XCYJ202104005.htm
[82] Huang MS, Peng YW, He QD, et al. NMR-based metabonomics reveals the dynamic effect of electro-acupuncture on central nervous system in gastric mucosal lesions(GML)rats[J]. Chin Med, 2022, 17(1): 37.
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