Gomez J C, Selvaggio G S, Viola M, Pizarro B, la Motta G, de Barrio S, Castelletto R, Echeverría R, Sugai E, Vazquez H, Mauriño E, Bai J C
Nutritional Support and Malabsorption Unit, San Martín Hospital, UNLP, La Plata, Argentina.
Am J Gastroenterol. 2001 Sep;96(9):2700-4. doi: 10.1111/j.1572-0241.2001.04124.x.
Up to now, the epidemiological characteristic of celiac disease among adults in South America remains unknown. The present prospective screening was designed to determine the prevalence of celiac disease in adults from the general population in an urban area of Argentina.
Between January. 1998, and May, 2000, all couples attending a centralized laboratory for an obligatory prenuptial examination in the La Plata area were offered participation in a screening program for celiac disease. The study included 2000 subjects (996 women; median age 29 yr, range 16-79 yr). All individuals completed a clinical questionnaire at the time that serum samples were obtained. A three-step screening protocol was used, as follows: 1) all samples were tested for antigliadin antibodies (AGAs) (type IgA and IgG); 2) samples that were IgA AGA positive were tested for antiendomysial antibody (EmA type IgA); samples that were positive for AGA-G but negative for IgA AGAs were tested for total IgA serum levels and EmA type IgG; and 3) subjects who were EmA-positive were referred for intestinal biopsy.
At the end of the screening we detected 10 subjects who were EmA-A positive and two others who were IgA-deficient (both were EmA-G positive). Up to now, 11 of the 12 subjects (including nine EmA-positive and two IgA-deficient subjects) had endoscopic intestinal biopsies showing the characteristic celiac histology. The remaining EmA-positive individual was considered to be affected by celiac disease. The overall prevalence assessed was 1:167 (6.0 x 1000 subjects; 95% CI = 3.1-10.5). Eight of the 12 (67%) subjects were female (1:124; 8.0 x 1000; 95% CI = 3.5-15.8) and four (33%) were male (1:251; 4.0 x 1000; 95% Cl = 1.1-10.2). Although eight new patients were considered to be asymptomatic, three presented with a subclinical course and one was classically symptomatic. Only one patient had been previously diagnosed with celiac disease.
Our screening protocol showed a very high prevalence of celiac disease for an urban area of Argentina that is ethnically similar to 90% of the general population of the country. The prevalence among women was double that for men, and the heterogeneous clinical picture of new patients showed predominance of asymptomatic cases.
迄今为止，南美洲成年人腹腔疾病的流行病学特征仍不清楚。本前瞻性筛查旨在确定阿根廷一个城市地区普通人群中成年人腹腔疾病的患病率。
在1998年1月至2000年5月期间，所有前往拉普拉塔地区一家集中实验室进行强制性婚前检查的夫妇都被邀请参加腹腔疾病筛查项目。该研究包括2000名受试者（996名女性；中位年龄29岁，范围16 - 79岁）。所有个体在采集血清样本时都完成了一份临床问卷。采用了三步筛查方案，如下：1）所有样本均检测抗麦胶蛋白抗体（AGA）（IgA和IgG型）；2）IgA AGA阳性的样本检测抗肌内膜抗体（EmA IgA型）；AGA - G阳性但IgA AGA阴性的样本检测总IgA血清水平和EmA IgG型；3）EmA阳性的受试者被转诊进行肠道活检。
筛查结束时，我们检测到10名EmA - A阳性受试者和另外2名IgA缺乏者（均为EmA - G阳性）。截至目前，12名受试者中的11名（包括9名EmA阳性和2名IgA缺乏受试者）经内镜肠道活检显示出典型的腹腔疾病组织学特征。其余EmA阳性个体被认为患有腹腔疾病。评估的总体患病率为1:167（每1000名受试者中有6.0例；95%可信区间 = 3.1 - 10.5）。12名受试者中有8名（67%）为女性（1:124；每1000名中有8.0例；95%可信区间 = 3.5 - 15.8），4名（33%）为男性（1:251；每1000名中有4.0例；可信区间 = 1.1 - 10.2）。虽然8名新患者被认为无症状，但3名表现为亚临床病程，1名有典型症状。只有1名患者此前被诊断患有腹腔疾病。
我们的筛查方案显示，在阿根廷一个与该国90%的普通人群种族相似的城市地区，腹腔疾病患病率非常高。女性患病率是男性的两倍，新患者的临床症状多样，无症状病例占主导。
