自身免疫性萎缩性胃炎(AAG)是一种持久的、局限于胃体部位的免疫介导的胃体酸性粘膜破坏，导致胃酸和内因子分泌减少，从而引起铁缺乏和恶性贫血，因铁和钴胺素吸收不良而产生。对壁细胞(PCA)和内因子(IFA)自身抗体的阳性率非常高。AAG可能多年保持无症状状态，因此其诊断复杂而延迟。由于存在胃肿瘤的风险增加，及时诊断AAG在临床上非常重要。AAG诊断的金标准是通过胃镜获取的胃活检进行组织病理学评估，但无创、术前血清学筛查可能在某些临床情况下有用。AAG的血清生物标志物可分为两组：与胃自身免疫相关的生物标志物，如PCA和IFA，以及与胃体萎缩/胃酸分泌减少相关的生物标志物，如血清胃泌素和胃蛋白酶原。本综述重点讨论了与胃自身免疫和胃体萎缩相关的血清生物标志物的临床意义和限制，并包括部分分析方法的讨论。PCA、IFA、胃泌素和胃蛋白酶原I的血清检测显示了良好的AAG无创诊断的准确性。通过结合这些测试中的一个或多个，可以提高诊断能力，以克服无抗体的AAG的问题。然而，还需要设计合适的、比较性的研究，以更好地确定这些生物标志物在AAG患者诊断中的可靠性，包括对病人队列的明确描述。目前，阳性的血清检测结果应始终进行最先进的诊断测试，即通过胃镜获取胃活检进行组织病理学评估，以终定确认或排除AAG和可能的恶性肿瘤并发症。© 2023年，诊断与实验室医学协会所有，保留所有权利。请发送电子邮件至：journals.permissions@oup.com以获取使用权限。

Autoimmune atrophic gastritis (AAG) is a persistent, corpus-restricted immune-mediated destruction of the gastric corpus oxyntic mucosa with reduced gastric acid and intrinsic factor secretion, leading to iron deficiency and pernicious anemia as a consequence of iron and cobalamin malabsorption. Positivity toward parietal cell (PCA) and intrinsic factor (IFA) autoantibodies is very common. AAG may remain asymptomatic for many years, thus making its diagnosis complex and often delayed. Due to the increased risk of gastric neoplasms, a timely diagnosis of AAG is clinically important.The gold standard for AAG diagnosis is histopathological assessment of gastric biopsies obtained during gastroscopy, but noninvasive, preendoscopic serological screening may be useful in some clinical scenarios. Serum biomarkers for AAG may be divided into 2 groups: gastric autoimmunity-related biomarkers, such as PCA and IFA, and gastric corpus atrophy/reduced gastric acid secretion-related biomarkers, such as serum gastrin and pepsinogens. The present review focuses on the clinical significance and pitfalls of serum biomarkers related to gastric autoimmunity and gastric corpus atrophy, including some discussion of analytical methods.Serum assays for PCA, IFA, gastrin, and pepsinogen I show good diagnostic accuracy for noninvasive diagnostic work-up of AAG. Diagnostic performance may increase by combining >1 of these tests, overcoming the problem of seronegative AAG. However, appropriately designed, comparative studies with well-characterized patient cohorts are needed to better define the reliability of these biomarkers in the diagnosis of patients with AAG. Currently, positive serum tests should always be followed by the state-of-art diagnostic test, that is, histopathological assessment of gastric biopsies obtained during gastroscopy to definitively confirm or rule out AAG and eventually neoplastic complications.© Association for Diagnostics & Laboratory Medicine 2023. All rights reserved. For permissions, please e-mail: journals.permissions@oup.com.