Murray Iain A, Bullimore David W, Long Richard G
Department of Gastroenterology, City Hospital, Nottingham, UK.
Eur J Gastroenterol Hepatol. 2003 Oct;15(10):1091-5. doi: 10.1097/00042737-200310000-00005.
In coeliac disease, inducible nitric oxide synthase activity in the duodenal mucosa is greatly increased, resulting in increased production of nitric oxide. We investigated whether this resulted in increased plasma concentrations of its stable end products (nitrate/nitrite: NOx).
Fasting plasma NOx was determined in 66 patients attending for upper gastrointestinal endoscopy. Of these, 21 had coeliac disease (nine were on a gluten-free diet). The remainder had a variety of other gastrointestinal disorders. NOx was determined using the Griess reaction. Distal duodenal biopsies for coeliac patients were graded according to the Marsh score.
Patients with untreated coeliac disease had a higher fasting NOx concentration (mean 117.5 microM) than either those with coeliac disease taking a gluten-free diet (mean 71.2 microM) or those with other diseases (mean 33.5 microM; one-way analysis of variance, P < 0.001). Coeliac patients with higher fasting NOx concentrations had more marked histological changes (P < 0.05).
Fasting plasma NOx is significantly elevated in untreated coeliac disease and correlates with histological grade. The potential clinical utility of serial NOx measurements to monitor improvement on a gluten-free diet requires further study.
在乳糜泻中，十二指肠黏膜中诱导型一氧化氮合酶活性大幅增加，导致一氧化氮生成增多。我们研究了这是否会导致其稳定终产物（硝酸盐/亚硝酸盐：NOx）的血浆浓度升高。
对66名接受上消化道内镜检查的患者测定空腹血浆NOx。其中，21人患有乳糜泻（9人采用无麸质饮食）。其余患者患有各种其他胃肠道疾病。使用格里斯反应测定NOx。根据马什评分对乳糜泻患者的十二指肠远端活检组织进行分级。
未经治疗的乳糜泻患者的空腹NOx浓度（平均117.5微摩尔）高于采用无麸质饮食的乳糜泻患者（平均71.2微摩尔）或其他疾病患者（平均33.5微摩尔；单因素方差分析，P<0.001）。空腹NOx浓度较高的乳糜泻患者有更明显的组织学变化（P<0.05）。
未经治疗的乳糜泻患者空腹血浆NOx显著升高，且与组织学分级相关。连续测量NOx以监测无麸质饮食改善情况的潜在临床实用性需要进一步研究。
