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Gastroenterology：超短乳糜泻的临床和免疫特征

2016-05-10 MedSci MedSci原创

超短乳糜泻十二指肠球部D1
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麸质敏感性肠病伴绒毛萎缩局限于十二指肠球部(D1)尚未被描述为成人乳糜泻。我们在检测腹腔疾病时，进行了D1组织活检，一定数量和部位的活检组织被用来检测超短乳糜泻(USCD，绒毛萎缩局限于D1)以及USCD的临床表型。该项前瞻性研究入组了1,378例在2008~2014年转诊至英国一所教学医院接受内镜检查的连续患者。常规十二指肠活检标本取自D1和十二指肠的其他部位（D2）。对171个有高度可疑乳糜泻

麸质敏感性肠病伴绒毛萎缩局限于十二指肠球部(D1)尚未被描述为成人乳糜泻。我们在检测腹腔疾病时，进行了D1组织活检，一定数量和部位的活检组织被用来检测超短乳糜泻(USCD，绒毛萎缩局限于D1)以及USCD的临床表型。

该项前瞻性研究入组了1,378例在2008~2014年转诊至英国一所教学医院接受内镜检查的连续患者。常规十二指肠活检标本取自D1和十二指肠的其他部位（D2）。对171个有高度可疑乳糜泻的连续患者进行二次取材（平均年龄46.5岁，64%女性）。

根据活检诊断为USCD的患者的临床数据与传统乳糜泻（CCD）（绒毛萎缩超过D1）患者和无乳糜泻患者（对照组）进行比较。对乳糜泻患者D1和D2的上皮间淋巴细胞（IELs）和免疫亚型进行比较。

结果发现：1378名进行评估的患者，268 (19.4%)诊断为乳糜泻；这类病人的9.7%绒毛萎缩局限于D1 (USCD; P < .0001)。单次附加D1任一部位的活检增加了9.3%–10.8% (P < .0001)的乳糜泻诊断率。

与CCD患者相比，USCD患者更年轻(P = .03)，有更低滴度的组织转谷氨酰胺酶抗体 (P = .001)和更少出现腹泻(P = .001)。更高比例的CCD患者有铁缺乏症 (P = .007) 或叶酸缺乏(P = .003)。

乳糜泻患者D1部位中位上皮内淋巴细胞(IELs)数量为50/100 肠细胞（ 50 IELs/100），D2部位中位数量为48 IELs/100 (P = .7)。无法根据IELs的表型区分D1乳糜泻和D2乳糜泻。

结论：单次附加D1任一部位的活检可显著提高乳糜泻诊断率。 USCD患者可能存在早期或局限性乳糜泻，伴有轻度的临床表型和罕见的营养缺乏。

原始出处：

Matthew Kurien, Kate E. Evans, et al,Clinical and Immunologic Features of Ultra-Short Celiac Disease,gastroenterology.2016.01.029


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    2017-04-04 智者为医08

    #Gastroenterol#

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    2016-07-06 许安

    #GAS#

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    2016-08-01 ms24272190615788285182

    #AST#

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    2016-05-11 surilei

    #免疫特征#

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    2016-05-11 chaojitidian

    #Gastroenterology#

    0