Gastroenterology:自身免疫进展与乳糜泻诊断研究

2020-01-06 MedSci MedSci原创

研究发现,在初次检测tTGA呈阴性的成年人中,只有不到1%的人在第二次检测中呈阳性。tT GA阳性成年人中,只有20%的人后来被诊断为乳糜泻

乳糜泻可与在任何年龄发病或发展,但是在未经内镜确诊的乳糜泻疑似人群中,组织转谷氨酰胺酶抗体(tTGA)血清学结果对乳糜泻诊断的效果尚未得到充分评估。

研究人员收集一家社区诊所中15551名成人血样,进行tTGA分析,如果滴度结果高于2u/mL,则进行人肌内膜抗体分析。血样采集时间为2006年至2017年,分2个时间点(中间间隔8.8年)。

在第一时间点采集的血清样本中,15398份tTGA呈阴性,153份tTGA呈阳性(>4u/mL)。根据医疗记录,6名患者诊断为乳糜泻,累计诊断发生率为0.06%。第一次tTGA血清学检查阴性的49例(0.32%)患者在第二次血清学检查呈阳性。在第一个时间点tT GA阳性的153名成年人中,31人(20%)随后诊断为乳糜泻,81名(53%)tT GA阳性人群临床诊断排除了乳糜泻,41人(27%)在第二个时间点tTGA检测结果为阴性。较高的初始tTGA滴度、女性、甲状腺功能减退和自身免疫性疾病史与后继乳糜泻风险增加相关。

研究发现,在初次检测tTGA呈阴性的成年人中,只有不到1%的人在第二次检测中呈阳性。tT GA阳性成年人中,只有20%的人后来被诊断为乳糜泻。

原始出处:

Rok Seon Choung et al. Community-Based Study of Celiac Disease Autoimmunity Progression in Adults. Gastroenterology. January 2020.

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  1. [GetPortalCommentsPageByObjectIdResponse(id=1004007, encodeId=ec69100400e18, content=<a href='/topic/show?id=24cf236e96e' target=_blank style='color:#2F92EE;'>#乳糜泻#</a>应该是一种<a href='/topic/show?id=e6488633e2c' target=_blank style='color:#2F92EE;'>#自身免疫性疾病#</a>,这种说法应该是比较可靠! 麦胶性肠病又称乳糜泻、非热带性脂肪泻,在北美、北欧、澳大利亚发病率较高,国内很少见。男女之比为1∶1.3~2.0,女性多于男性,发病高峰年龄主要是儿童与青年,但近年来老年人发病率在增高。本病与进食麦粉关系密切,大量研究已证实麦胶可能是本病的致病因素,并认为发病原因是遗传、免疫和麦胶饮食相互作用的结果。 本病患者对含麦胶(俗称面筋)的麦粉食物异常敏感,大麦、小麦、黑麦、燕麦中的麦胶可被乙醇分解为麦胶蛋白(即麦素gliadin),其可能为本病的致病因素。正常人小肠黏膜细胞内有多肽分解酶,可将其分解为更小分子的无毒物质,但在活动性乳糜泻病人,肠黏膜细胞酶活性不足,不能将其分解而致病。, beContent=null, objectType=article, channel=null, level=null, likeNumber=123, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=23679, encryptionId=24cf236e96e, topicName=乳糜泻), TopicDto(id=86337, encryptionId=e6488633e2c, topicName=自身免疫性疾病)], attachment=null, authenticateStatus=null, createdAvatar=https://img.medsci.cn/20220519/c2ab253484ee4527a2d4e9589a4821ac/45de9bf494a54becb2ea4369c9d11e85.jpg, createdBy=7a3710, createdName=小小医者, createdTime=Fri Jul 30 21:46:26 CST 2021, time=2021-07-30, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=2064945, encodeId=dc222064945a9, content=<a href='/topic/show?id=94ffe853a7' target=_blank style='color:#2F92EE;'>#Gastroenterol#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=26, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=7853, encryptionId=94ffe853a7, topicName=Gastroenterol)], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=0bed488, createdName=jktdtl, createdTime=Sun Apr 26 14:19:00 CST 2020, time=2020-04-26, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1712264, encodeId=623e1e1226453, content=<a href='/topic/show?id=9a1c289680' target=_blank style='color:#2F92EE;'>#AST#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=32, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=2896, encryptionId=9a1c289680, topicName=AST)], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=8b9831894722, createdName=ms24272190615788285182, createdTime=Sun May 10 14:19:00 CST 2020, time=2020-05-10, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=2072847, encodeId=bb8d20e2847cd, content=<a href='/topic/show?id=9d4ee84647' target=_blank style='color:#2F92EE;'>#GAS#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=38, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=7846, encryptionId=9d4ee84647, topicName=GAS)], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=e2dd327, createdName=许安, createdTime=Sat Dec 19 05:19:00 CST 2020, time=2020-12-19, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1504890, encodeId=d0431504890a3, content=<a href='/topic/show?id=7730e85412' target=_blank style='color:#2F92EE;'>#Gastroenterology#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=35, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=7854, encryptionId=7730e85412, topicName=Gastroenterology)], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=5fc29706655, createdName=chaojitidian, createdTime=Wed Jan 08 10:19:00 CST 2020, time=2020-01-08, status=1, ipAttribution=)]
    2021-07-30 小小医者

    #乳糜泻#应该是一种#自身免疫性疾病#,这种说法应该是比较可靠! 麦胶性肠病又称乳糜泻、非热带性脂肪泻,在北美、北欧、澳大利亚发病率较高,国内很少见。男女之比为1∶1.3~2.0,女性多于男性,发病高峰年龄主要是儿童与青年,但近年来老年人发病率在增高。本病与进食麦粉关系密切,大量研究已证实麦胶可能是本病的致病因素,并认为发病原因是遗传、免疫和麦胶饮食相互作用的结果。 本病患者对含麦胶(俗称面筋)的麦粉食物异常敏感,大麦、小麦、黑麦、燕麦中的麦胶可被乙醇分解为麦胶蛋白(即麦素gliadin),其可能为本病的致病因素。正常人小肠黏膜细胞内有多肽分解酶,可将其分解为更小分子的无毒物质,但在活动性乳糜泻病人,肠黏膜细胞酶活性不足,不能将其分解而致病。

    0

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    2020-12-19 许安
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