de Freitas Isabella Nicácio, Sipahi Aytan Miranda, Damião Adérson O M C, de Brito Thales, Cançado Eduardo Luiz Rachid, Leser Paulo Guilherme, Laudanna Antonio Atilio
Laboratory of Medical Investigation (LIM-07), Hospital das Clínicas, School of Medicine of the University of São Paulo, São Paulo, Brazil.
J Clin Gastroenterol. 2002 Apr;34(4):430-4. doi: 10.1097/00004836-200204000-00009.
Forty-eight adult patients with celiac disease between 15 and 68 years of age (mean, 41 years) were studied. Sixty-seven percent were female and 33% were male patients. Most of the patients were white (98%). The main clinical features were diarrhea (90%), weight loss (70%), and abdominal pain (56%). On physical examination, the main findings were pallor (40%), aphthous stomatitis (31%), and arthralgia (23%). Associated disorders included diabetes mellitus type I, osteoporosis, and atopy (6% each); dermatitis herpetiformis and depression (4% each); and hypothyroidism, hyperthyroidism, duodenal carcinoma, and Gilbert syndrome (2% each). The histologic results according to Marsh criteria (modified by Rostami) are as follows: type I, 10%; type II, 21%; type IIIa, 19%; type IIIb, 17%; and type IIIc, 33%. The sensitivity and specificity for the antiendomysium antibody-immunoglobulin A test were 92% and 100%, respectively, when considering the whole group of patients; however, the sensitivity (but not the specificity) decreased to 86% when taking into account only the group of patients with mild histologic alterations (Marsh type I, II, and IIIa).
In general, the authors' results are similar to those described in developing countries, indicating that celiac disease might have the same spectrum of presentation regardless of the region studied.
对48例年龄在15至68岁(平均41岁)的成年乳糜泻患者进行了研究。67%为女性患者,33%为男性患者。大多数患者为白人(98%)。主要临床特征为腹泻(90%)、体重减轻(70%)和腹痛(56%)。体格检查的主要发现为面色苍白(40%)、阿弗他口炎(31%)和关节痛(23%)。相关疾病包括I型糖尿病、骨质疏松症和特应性疾病(各占6%);疱疹样皮炎和抑郁症(各占4%);以及甲状腺功能减退症、甲状腺功能亢进症、十二指肠癌和吉尔伯特综合征(各占2%)。根据Marsh标准(由Rostami修改)的组织学结果如下:I型,10%;II型,21%;IIIa型,19%;IIIb型,17%;IIIc型,33%。考虑整个患者组时,抗肌内膜抗体免疫球蛋白A检测的敏感性和特异性分别为92%和100%;然而,仅考虑组织学改变较轻的患者组(Marsh I型、II型和IIIa型)时,敏感性(而非特异性)降至86%。
总体而言,作者的结果与发展中国家描述的结果相似,表明无论研究的地区如何,乳糜泻可能具有相同的表现谱。