Vitamins D and B₁₂, homocysteine and laboratory markers of chronic atrophic gastritis in Chernobyl liquidators with metabolic syndrome

Relevance. An in-depth examination of Chernobyl liquidators treated at the Nikiforov Russian Center of Emergency and Radiation Medicine showed a higher incidence of chronic atrophic gastritis versus the comparison group. When combined with metabolic syndrome, the disease has vague and diverse clinical manifestations. Due to poor compliance among patients regarding invasive diagnostic procedures and elevated risk of chronic atrophic gastritis progressing into gastric adenocarcinoma, an extensive laboratory assessment is required to understand the grade of disorder in Chernobyl liquidators with metabolic syndrome.

The study objective is to identify laboratory markers responsible for the chronic atrophic gastritis and metabolic syndrome comorbidity development in Chernobyl liquidators

Methods. 97 male Chernobyl liquidators were divided into two groups – with and without metabolic syndrome. Pepsinogen-I, pepsinogen-II, gastrin-17 and H. pylori-IgG concentration in blood plasma was assessed quantitatively using enzyme immunoassay with “Gastropanel” (BIOHIT, Finland) reagent system in accordance with the manufacturer’s guidelines. Serum vitamin D (Access 2, Beckman Coulter, USA), vitamin B12 (UniCel DXi, Beckman Coulter, USA) and homocysteine (Immulite 2000 XPI, Siemens, USA) were measured using chemiluminescent immunoassay. Statistical analysis was performed using Statistica 10.0.

Results and discussion. In the presence of metabolic syndrome both in Chernobyl liquidators and the comparison group, laboratory assessment showed higher detection frequency of gastric mucosal atrophy. In Chernobyl liquidators, the combination of vitamin B 12 deficiency and metabolic syndrome was associated with a doubled blood level of gastrin-17, while the median concentration was four times higher than the upper reference limit. Pepsinogen I level was below 70 mcg/L in 57.1 % of cases with combined B 12 deficiency and metabolic syndrome. In 70 % of cases, Chernobyl liquidators with fundal chronic atrophic gastritis revealed a combination of disorders, namely: vitamin B12 deficiency, hyperhomocysteinemia, pepsinogen I < 30 mcg/L, gastrin-17 > 30 pmol/L, pepsinogen I/pepsinogen II < 3. Moreover, Chernobyl liquidators with fundal chronic atrophic gastritis, showed vitamin D deficiency regardless of metabolic syndrome diagnosis. Vitamin D level in Chernobyl liquidators with antral chronic atrophic gastritis and without metabolic syndrome corresponded was within reference, while in the presence of metabolic syndrome, vitamin D level was close to deficiency.

Conclusion. Laboratory findings demonstrate that in Chernobyl liquidators, metabolic syndrome and vitamin B12 deficiency are associated with a greater severity of atrophic changes in the stomach mucous membrane. This justifies the need for homocysteine, vitamins D and B12 lab tests to be included in the clinical and laboratory health monitoring of Chernobyl liquidators with combined metabolic syndrome and chronic atrophic gastritis comorbidity.

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