Troncone Riccardo, Franzese Adriana, Mazzarella Giuseppe, Paparo Francesco, Auricchio Renata, Coto Iolanda, Mayer Marina, Greco Luigi
Department of Pediatrics and European Laboratory for the Investigation of Food-Induced Diseases, University Federico II, Naples, Italy.
Am J Gastroenterol. 2003 Mar;98(3):590-5. doi: 10.1111/j.1572-0241.2003.07301.x.
The association between celiac disease and insulin dependent diabetes mellitus (IDDM) is well established. Rectal gluten challenge has been used in patients with celiac disease and in first degree relatives as a tool to assess the mucosal immune response to gluten. The aim of this study was to assess the mucosal immune response to gluten in IDDM children by rectal gluten challenge.
Rectal biopsy specimens were obtained from 19 children with IDDM before and 6 h after rectal challenge with 2 g of a peptic tryptic digest of gliadin. A total of 16 treated celiac patients and 10 control subjects were also investigated. Epithelium and lamina propria CD3(+) and gamma delta(+) lymphocytes were counted with reference to a standard reference area of muscularis mucosae (10(4) microm(2)).
After a local instillation of gliadin, a significant (>mean + 1 SD) percentage increment of lamina propria and epithelium CD3(+) and of lamina propria and epithelium gamma delta(+) lymphocytes was observed in five IDDM children, as compared to 11 and 13 celiac patients and one and two controls, respectively. A discriminant analysis allowed correct classification of 100% of patients with celiac disease and controls. The same analysis classified four of 19 IDDM children in the group of celiac patients. The positivity was associated with normal serology (antigliadin antibody, antiendomysial antibody, and antitissue transglutaminase antibodies) and a morphologically normal jejunal mucosa. All four patients had HLA-DQ alleles associated with celiac disease.
Approximately 20% of IDDM children react to rectal instillation of gliadin. Long term follow-up is necessary to establish whether these subjects are at increased risk for developing celiac disease.
乳糜泻与胰岛素依赖型糖尿病（IDDM）之间的关联已得到充分证实。直肠麸质激发试验已用于乳糜泻患者及其一级亲属，作为评估对麸质的黏膜免疫反应的一种手段。本研究的目的是通过直肠麸质激发试验评估IDDM儿童对麸质的黏膜免疫反应。
对19名IDDM儿童在直肠给予2g麦醇溶蛋白的胰蛋白酶消化物激发前及激发后6小时获取直肠活检标本。还对16名接受治疗的乳糜泻患者和10名对照受试者进行了研究。参照黏膜肌层的标准参考区域（10⁴平方微米）对上皮和固有层中的CD3⁺和γδ⁺淋巴细胞进行计数。
与分别为11名和13名乳糜泻患者以及1名和2名对照相比，在5名IDDM儿童中，局部滴注麦醇溶蛋白后，观察到固有层和上皮中CD3⁺以及固有层和上皮中γδ⁺淋巴细胞有显著（>平均值+1个标准差）的百分比增加。判别分析能够正确分类100%的乳糜泻患者和对照。相同分析将19名IDDM儿童中的4名归入乳糜泻患者组。阳性反应与血清学正常（抗麦醇溶蛋白抗体、抗肌内膜抗体和抗组织转谷氨酰胺酶抗体）以及形态学上正常的空肠黏膜相关。所有4名患者都具有与乳糜泻相关的HLA - DQ等位基因。
约20%的IDDM儿童对直肠滴注麦醇溶蛋白有反应。需要进行长期随访以确定这些受试者患乳糜泻的风险是否增加。
