潜在性腹腔疾病的遗传学、形态学和免疫组织化学标志物
Genetic, morphometric and immunohistochemical markers of latent coeliac disease.
作者信息
Johnston S D, Watson R G, Middleton D, McMillan S A, Maxwell P, Hamilton P, Love A H
机构信息
Department of Medicine, Queen's University, Belfast, Northern Ireland, UK.
出版信息
Eur J Gastroenterol Hepatol. 1999 Nov;11(11):1283-8. doi: 10.1097/00042737-199911000-00017.
BACKGROUND
It is recognized that coeliac disease may exist in a latent form characterized by HLA-DR3 and increased counts of intra-epithelial lymphocytes (IELs) and gamma/delta T cells in jejunal biopsies. To determine whether subjects with persistent serological markers 4 and 13 years after a population screening survey have the HLA constitution of coeliac disease and/or minor morphometric abnormalities of the small intestine, including raised gamma/delta T-cell counts, as possible indicators of latent coeliac disease.
SUBJECTS
Participants with positive serology detected by the Belfast MONICA Project surveys (1983 and 1991) were subdivided into those with persistently positive serology (persistent serology), negative serology at follow-up (transient serology) and those with enteropathy (coeliac disease). Morphometric features were compared with MONICA controls who had negative serology and HLA antigen frequencies were compared with blood donor controls.
METHODS
Subjects were followed up in 1994-1996 and were re-tested for IgA antibodies to gliadin, endomysium and reticulin. HLA typing was carried out and IELs and gamma/delta T-cell counts were assessed in jejunal biopsies in subjects who gave consent.
RESULTS
Persistent serology mainly concerned antigliadin (AGA) and antireticulin (ARA) antibodies but one patient had positive antiendomysial antibody (EMA) and ARA in 1983, which became negative at follow-up, at which time they were positive for AGA. No significant differences were observed between IELs or gamma/delta T-cell counts when the persistent and transient groups were compared in turn with the MONICA controls. HLA-DR2 was expressed in 11 of 16 in the persistent group compared to 47 of 150 blood donor controls (P = 0.013). HLA-DR3 occurred in 15 of 17 coeliac patients compared to 37 of 150 blood donors (P = 0.00001).
CONCLUSIONS
Persistent serological markers following population screening do not appear to indicate latent coeliac disease.
背景
人们认识到，乳糜泻可能以潜伏形式存在，其特征为HLA - DR3以及空肠活检中上皮内淋巴细胞（IELs）和γ/δ T细胞计数增加。为了确定在人群筛查调查4年和13年后具有持续血清学标志物的受试者是否具有乳糜泻的HLA构成和/或小肠的轻微形态计量学异常，包括升高的γ/δ T细胞计数，作为潜伏性乳糜泻的可能指标。
受试者
由贝尔法斯特莫尼卡项目调查（1983年和1991年）检测出血清学阳性的参与者被细分为血清学持续阳性（持续血清学）、随访时血清学阴性（短暂血清学）以及患有肠病（乳糜泻）的参与者。将形态计量学特征与血清学阴性的莫尼卡对照组进行比较，并将HLA抗原频率与献血者对照组进行比较。
方法
在1994 - 1996年对受试者进行随访，并再次检测针对麦醇溶蛋白、肌内膜和网硬蛋白的IgA抗体。进行HLA分型，并对同意的受试者进行空肠活检，评估IELs和γ/δ T细胞计数。
结果
持续血清学主要涉及抗麦醇溶蛋白（AGA）和抗网硬蛋白（ARA）抗体，但有一名患者在1983年抗肌内膜抗体（EMA）和ARA呈阳性，随访时变为阴性，此时他们的AGA呈阳性。当将持续组和短暂组依次与莫尼卡对照组进行比较时，IELs或γ/δ T细胞计数未观察到显著差异。持续组16人中11人表达HLA - DR2，而150名献血者对照组中有47人表达（P = 0.013）。17名乳糜泻患者中有15人出现HLA - DR3，而150名献血者中有37人出现（P = 0.00001）。
结论
人群筛查后持续的血清学标志物似乎并不表明潜伏性乳糜泻。
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