抄録
Intrinsic Factor (IF) antibody, parietal cell (PC) antibody, gastric secretion, histology of gastric mucosa and effect of prednisolone therapy were studied in order to investigate pathogenic significance of IF antibody in pernicious anemia (PA). 40 cases of PA, 416 cases which are subject to have atrophic gastritis and 217 cases of control were examined.
PC antibody was positive in 90% of PA, however significant number of other diseases which tend to have atrophic gastritis have also positive PC antibody, compared with control. PC antibody was examined in 97 cases except for PA by biopsy of gastric mucosa, but PC antibody did not have meaningful relation between its titer and the nature or the degree of gastritis. And there was no relation among PC antibody titer, acid secretion and IF secretion.
Concerning IF antibody, 55% of PA were positive in blocking antibody, but out of 633 cases excluding PA, the only one had positive blocking antibody and this case had hyperfunction of thyroid gland and revealed marked diminished secretion of IF, which was quite similar to PA.
When gastric mucosa of 18 PA and 1 hyperthyroidism were examined microscopically, all the cases which showed marked intestinal metaplasia of gastric mucosa had had no blocking antibody.
8 of 27 PA revealed positive blocking antibody in gastric juice. When IF and blocking antibody were separated by acidifing gastric juice of PA with HCl, appearance of IF activity was proved in gastric juice of 5 PA.
The effect of long term prednisolone therapy had been studied in 9 cases of PA, 5 cases of simple atrophic gastritis and 2 caces of total gastrectomy. During prednisolone treatment, 4 cases showed improvement of Schilling test, and simultaneously regeneration of perietal cells, elevation of IF activity and diminution of circulating blocking antibody. 3 of above 4 cases were proved to have positive circulating blocking antibody, the rest of them was the case in which IF activity appeared in gastric juice after HCl treatment. There were no significant change of tests in 5 cases which revealed negative blocking antibody in spite of prednisolone administration. No appreciable effect was also seen to all atrophic gastritis and gastrectomised cases. PC antibody titer remained same.
From these results, it is considered that PC antibody is one of autoimmune phenomena which is not concerned with the pathologenesis of PA. However blocking antibody is thought to be related to disturbance of IF secretion in AP.
