Demir H, Yüce A, Koçak N, Ozen H, Gürakan F
Department of Pediatrics, Hacettepe University, Faculty of Medicine, Ankara, Turkey.
Pediatr Int. 2000 Oct;42(5):483-7. doi: 10.1046/j.1442-200x.2000.01286.x.
Celiac disease is characterized by life-long gluten intolerance. Clinical features of patients with celiac disease are variable. In the present study, clinical, laboratory and histologic features of 104 patients with celiac disease were evaluated.
Intestinal biopsy and serum antigliadin and anti-endomysium antibodies were used for the diagnosis of patients. Mucosal lesions were classified according to the criteria of Marsh. Antigliadin antibodies were measured with a commercial enzyme-linked immunosorbent assay. Anti-endomysium antibodies were analyzed by indirect immunofluorescence with the use of a section of monkey esophagus. Routine hematological and biochemical analyses and measurement of immunoglobulin levels were undertaken.
The mean (+/- SD) patient age was 5.9 +/- 4.1 years (range 10 months-16 years) and the most common symptom was diarrhea (81.7%) followed by abdominal distention, weight loss, anorexia and failure to thrive. Abdominal distention (60.6%), short stature (45.2%) and iron-deficiency anemia were the most common findings. High serum alanine aminotransferase levels were found in 38.3% of patients and these levels became normal after adoption of a gluten-free diet in all but two patients with cirrhosis. Immunoglobulin A, IgG antigliadin antibodies and IgA anti-endomysium antibodies were found in 76, 94 and 90% of patients, respectively. Biopsy of the small intestine revealed that 95, two and seven patients had type 3, type 2, and type 1 lesions, respectively, according to the Marsh classification. There was no statistically significant difference between patients and control groups with regard to antinuclear antibody, antismooth muscle antibody, anti-DNA and anticardiolipin antibodies (IgG and IgM).
Although classical celiac disease was seen in most patients in the present study, clinical variability of the condition should be kept in mind. In particular, patients with uncommon findings, such as short stature, cryptogenic liver disease and iron-deficiency anemia, should also be screened for celiac disease.
乳糜泻的特征是终生对麸质不耐受。乳糜泻患者的临床特征各不相同。在本研究中，对104例乳糜泻患者的临床、实验室和组织学特征进行了评估。
采用肠道活检以及血清抗麦醇溶蛋白和抗肌内膜抗体对患者进行诊断。根据马什标准对黏膜病变进行分类。使用商用酶联免疫吸附测定法检测抗麦醇溶蛋白抗体。通过使用一段猴食管进行间接免疫荧光分析抗肌内膜抗体。进行常规血液学和生化分析以及免疫球蛋白水平测定。
患者的平均（±标准差）年龄为5.9±4.1岁（范围为10个月至16岁），最常见的症状是腹泻（81.7%），其次是腹胀、体重减轻、厌食和发育不良。腹胀（60.6%）、身材矮小（45.2%）和缺铁性贫血是最常见的表现。38.3%的患者血清丙氨酸氨基转移酶水平升高，除两名肝硬化患者外，所有患者采用无麸质饮食后这些水平均恢复正常。分别在76%、94%和90%的患者中发现免疫球蛋白A、IgG抗麦醇溶蛋白抗体和IgA抗肌内膜抗体。根据马什分类，小肠活检显示9�、2例和7例患者分别有3型、2型和1型病变。患者组与对照组在抗核抗体、抗平滑肌抗体、抗DNA和抗心磷脂抗体（IgG和IgM）方面无统计学显著差异。
尽管本研究中的大多数患者表现为典型的乳糜泻，但应牢记该病的临床变异性。特别是，对于身材矮小、隐源性肝病和缺铁性贫血等不常见表现的患者，也应筛查乳糜泻。
