中华内科杂志
中華內科雜誌
중화내과잡지
CHINESE JOURNAL OF INTERNAL MEDICINE
2014年
11期
884-889
,共6页
麦胶肠病%非麦胶肠病性麦胶敏感%诊断%治疗
麥膠腸病%非麥膠腸病性麥膠敏感%診斷%治療
맥효장병%비맥효장병성맥효민감%진단%치료
Coeliac disease%Non-coeliac gluten sensitivity%Diagnosis%Therapy
目的 增强对麦胶相关疾病的认识,提高对麦胶相关疾病的诊断及治疗水平.方法 对疑诊麦胶相关疾病患者,在摄入含麦胶饮食时检测血清中抗麦胶蛋白抗体(AGA)、抗组织转谷氨酰胺酶(tTG)抗体、抗脱氨基麦胶蛋白(DGP)抗体、食物不耐受14项水平.血清抗体1项及以上阳性者进一步检查HLA-DQ2、HLA-DQ8,行内镜检查并镜下小肠黏膜多点活检.血清抗体阳性患者予无麦胶饮食治疗,其中1例同时口服泼尼松(30 mg/d,每周递减5 mg至停药),观察疗效.结果 13例患者均为血清抗体阳性,9例确诊为麦胶肠病,4例拟诊为非麦胶肠病性麦胶敏感(NCGS).无麦胶饮食治疗后,12例疗效满意,1例无改善.麦胶肠病组中6例患者同时合并其他疾病(主要是自身免疫病及骨质疏松).麦胶肠病组9例患者中AGA和tTG抗体阳性者分别为9例和2例,2例患者AGA和tTG抗体同时阳性,NCGS组4例患者中AGA阳性4例,未发现tTG抗体阳性患者.13例患者均接受内镜下小肠黏膜活检,9例病理结果显示麦胶肠病的特征性表现;4例患者肠上皮下见大量淋巴细胞浸润,无绒毛萎缩.2例NCGS患者分别于无麦胶饮食4、6个月后再次摄入含麦胶饮食,排便次数仅稍增加至1 ～3次/d,无其他不适.结论 麦胶肠病血清特异性抗体及特征性组织学改变是诊断麦胶肠病的金标准.麦胶肠病可合并多种自身免疫病,骨代谢性疾病亦非少见.终身严格的无麦胶饮食可能是最基础而有效的治疗.
目的 增彊對麥膠相關疾病的認識,提高對麥膠相關疾病的診斷及治療水平.方法 對疑診麥膠相關疾病患者,在攝入含麥膠飲食時檢測血清中抗麥膠蛋白抗體(AGA)、抗組織轉穀氨酰胺酶(tTG)抗體、抗脫氨基麥膠蛋白(DGP)抗體、食物不耐受14項水平.血清抗體1項及以上暘性者進一步檢查HLA-DQ2、HLA-DQ8,行內鏡檢查併鏡下小腸黏膜多點活檢.血清抗體暘性患者予無麥膠飲食治療,其中1例同時口服潑尼鬆(30 mg/d,每週遞減5 mg至停藥),觀察療效.結果 13例患者均為血清抗體暘性,9例確診為麥膠腸病,4例擬診為非麥膠腸病性麥膠敏感(NCGS).無麥膠飲食治療後,12例療效滿意,1例無改善.麥膠腸病組中6例患者同時閤併其他疾病(主要是自身免疫病及骨質疏鬆).麥膠腸病組9例患者中AGA和tTG抗體暘性者分彆為9例和2例,2例患者AGA和tTG抗體同時暘性,NCGS組4例患者中AGA暘性4例,未髮現tTG抗體暘性患者.13例患者均接受內鏡下小腸黏膜活檢,9例病理結果顯示麥膠腸病的特徵性錶現;4例患者腸上皮下見大量淋巴細胞浸潤,無絨毛萎縮.2例NCGS患者分彆于無麥膠飲食4、6箇月後再次攝入含麥膠飲食,排便次數僅稍增加至1 ～3次/d,無其他不適.結論 麥膠腸病血清特異性抗體及特徵性組織學改變是診斷麥膠腸病的金標準.麥膠腸病可閤併多種自身免疫病,骨代謝性疾病亦非少見.終身嚴格的無麥膠飲食可能是最基礎而有效的治療.
목적 증강대맥효상관질병적인식,제고대맥효상관질병적진단급치료수평.방법 대의진맥효상관질병환자,재섭입함맥효음식시검측혈청중항맥효단백항체(AGA)、항조직전곡안선알매(tTG)항체、항탈안기맥효단백(DGP)항체、식물불내수14항수평.혈청항체1항급이상양성자진일보검사HLA-DQ2、HLA-DQ8,행내경검사병경하소장점막다점활검.혈청항체양성환자여무맥효음식치료,기중1례동시구복발니송(30 mg/d,매주체감5 mg지정약),관찰료효.결과 13례환자균위혈청항체양성,9례학진위맥효장병,4례의진위비맥효장병성맥효민감(NCGS).무맥효음식치료후,12례료효만의,1례무개선.맥효장병조중6례환자동시합병기타질병(주요시자신면역병급골질소송).맥효장병조9례환자중AGA화tTG항체양성자분별위9례화2례,2례환자AGA화tTG항체동시양성,NCGS조4례환자중AGA양성4례,미발현tTG항체양성환자.13례환자균접수내경하소장점막활검,9례병리결과현시맥효장병적특정성표현;4례환자장상피하견대량림파세포침윤,무융모위축.2례NCGS환자분별우무맥효음식4、6개월후재차섭입함맥효음식,배편차수부초증가지1 ～3차/d,무기타불괄.결론 맥효장병혈청특이성항체급특정성조직학개변시진단맥효장병적금표준.맥효장병가합병다충자신면역병,골대사성질병역비소견.종신엄격적무맥효음식가능시최기출이유효적치료.
Objective To explore the diagnosis and treatment of gluten-related disorders (GRD).Methods Anti-gliadin antibodies (AGA),anti-tissue transglutaminase (tTG) antibody,deamidated gliadin peptides(DGP) antibody and serum specific IgG antibodies of 14 kinds of intolerable food were tested in people who developed chronic diarrhea after the intake of gluten diet.HLA-DQ2,HLA-DQ8 and intestinal endoscopic multiple biopsies would be performed further in patients with positive coeliac disease (CD)-specific serology.Gluten free diet was given to patients with positive CD-specific serology.One patient received prednisone (30 mg/d and diminished 5 rmg/w).Results Nine patients were confirmed with celiac disease(CD) and four cases were suspected non-coeliac gluten sensitivity (NCGS) in 13 patients with positive serologic tests.Twelve cases received effective therapy.In CD group,6 cases were accompanied with comorbidities mainly autoimmune diseases and osteoporosis.The positive rates of AGA and tTG antibody were 9/9 and 2/9 respectively in the CD group,while tTG antibody in the NCGS group were both negative.Endoscopic intestinal biopsy was performed in all 13 cases.Plasma cell proliferation and lymphocyte infiltration in the lamina propria without villus atrophy were identified in 4 cases,representing chronic inflammation of the small intestine.Villus atrophy was detected in 9 cases.Two patients with NCGS ingested gluten after 4 and 6 months of gluten-free diet respectively,and the number of bowel movements increased 1-2 times per day.Conclusions The diagnosis of CD is mainly based on serologic tests and characteristic of histological features.CD may be companied by other autoimmune diseases or metabolic disease of bone.Lifelong adherence to a gluten free diet is the most basic and effective therapy.
