Michaëlsson G, Gerdén B, Hagforsen E, Nilsson B, Pihl-Lundin I, Kraaz W, Hjelmquist G, Lööf L
Departments of Dermatology and Venereology, *Clinical Immunology, Pathology and Internal Medicine, University Hospital, S-751 85 Uppsala, Sweden.
Br J Dermatol. 2000 Jan;142(1):44-51. doi: 10.1046/j.1365-2133.2000.03240.x.
In a previous screening study, 16% of patients with psoriasis had IgA and/or IgG antibodies to gliadin (AGA). The aim of the present study was to evaluate the effect of a gluten-free diet (GFD) in 33 AGA-positive and six AGA-negative psoriasis patients. Of the 33 AGA-positive patients, two had IgA antibodies to endomysium (EmA) and 15 an increased number of lymphocytes in the duodenal epithelium, but in some this increase was slight. Two patients had villous atrophy. A 3-month period on a GFD was followed by 3 months on the patient's ordinary diet. The severity of psoriasis was evaluated with the psoriasis area and severity index (PASI). The examining dermatologists were unaware of the EmA and duodenal biopsy results throughout the study. Thirty of the 33 patients with AGA completed the GFD period, after which they showed a highly significant decrease in mean PASI. This included a significant decrease in the 16 AGA-positive patients with normal routine histology in duodenal biopsy specimens. The AGA-negative patients were not improved. After GFD, the AGA values were lower in 82% of those who improved. There was a highly significant decrease in serum eosinophil cationic protein in patients with elevated AGA. When the ordinary diet was resumed, the psoriasis deteriorated in 18 of the 30 patients with AGA who had completed the GFD period. In conclusion, psoriasis patients with raised AGA might improve on a GFD even if they have no EmA or if the increase in duodenal intraepithelial lymphocytes is slight or seemingly absent.
在之前的一项筛查研究中，16%的银屑病患者存在针对麦醇溶蛋白的IgA和/或IgG抗体（麦醇溶蛋白抗体）。本研究的目的是评估无麸质饮食（GFD）对33例麦醇溶蛋白抗体阳性和6例麦醇溶蛋白抗体阴性的银屑病患者的影响。在33例麦醇溶蛋白抗体阳性患者中，2例有抗肌内膜IgA抗体（EmA），15例十二指肠上皮淋巴细胞数量增加，但其中一些增加不明显。2例患者有绒毛萎缩。先进行3个月的无麸质饮食，随后3个月恢复患者的常规饮食。用银屑病面积和严重程度指数（PASI）评估银屑病的严重程度。在整个研究过程中，检查的皮肤科医生不知道抗肌内膜抗体和十二指肠活检结果。33例麦醇溶蛋白抗体阳性患者中有30例完成了无麸质饮食期，之后他们的平均PASI显著下降。这包括16例十二指肠活检标本常规组织学正常的麦醇溶蛋白抗体阳性患者的显著下降。麦醇溶蛋白抗体阴性患者没有改善。无麸质饮食后，82%病情改善的患者麦醇溶蛋白抗体值降低。麦醇溶蛋白抗体升高的患者血清嗜酸性粒细胞阳离子蛋白显著降低。当恢复常规饮食时，30例完成无麸质饮食期的麦醇溶蛋白抗体阳性患者中有18例银屑病病情恶化。总之，即使没有抗肌内膜抗体，或者十二指肠上皮内淋巴细胞增加不明显或似乎没有增加，麦醇溶蛋白抗体升高的银屑病患者采用无麸质饮食也可能改善。
