Kapur Gaurav, Patwari A K, Narayan Shashi, Anand V K
Division of Pediatric Gastroenterology and Nutrition, Department of Pediatrics, Kalawati Saran Children's Hospital, New Delhi.
Indian J Pediatr. 2003 Dec;70(12):955-8. doi: 10.1007/BF02723818.
To evaluate the effect of iron supplementation, in addition to gluten free diet (GFD), on hematological profile of children with Celiac Disease (CD).
Children diagnosed as CD as per modified ESPGAN criteria were prospectively evaluated for their hematological profile at the time of their enrolment and after consuming GFD for at least one year. The results were compared with age and sex matched controls. Evaluation of hematological profile included hemoglobin estimation, complete blood counts, peripheral blood smear examination, serum iron, total iron binding capacity (TIBC), and serum ferritin estimation. All the enrolled cases were given iron supplementation in addition to exclusion of gluten from their diet. Repeat intestinal biopsy was performed in all the cases after completing 1 year on GFD.
Twenty one children (mean age 6.67 years, range 4-11 years) diagnosed as CD who completed at least one year of regular follow up on GFD (mean 1.5 years, range 1-2 years) were analysed for their hematological profile at the time of enrolment and after consuming GFD and iron supplementation. At the time of enrolment all the children had hemoglobin level <11 gm%, 78% had microcytic hypochromic anemia and 22% had dimorphic anemia, with lower mean MCV, MCH and serum ferritin levels, and a significantly higher mean TIBC as compared to controls (p<0.001). In the follow up evaluation of these cases on GFD, mean hemoglobin levels were comparable with controls but the cases continued to have lower mean MCV, MCH serum ferritin levels (p<0.05) and higher mean TIBC (p<0.05). Seven children had mild anemia. Serum ferritin levels showed a negative correlation with the grade of villous atrophy and lamina propria infiltrate.
Our results suggest that iron deficiency anemia (IDA) is commonly associated with CD and iron deficiency state continues for a longer time even after excluding gluten from the diet and iron supplementation. Apart from offering them GFD rich in iron, early detection and treatment of IDA and prophylactic iron folic acid supplementation will go a long way to optimize their mental and psychomotor functions.
评估除无麸质饮食（GFD）外，补充铁剂对乳糜泻（CD）患儿血液学指标的影响。
根据改良的欧洲儿科胃肠病、肝病和营养学会（ESPGAN）标准诊断为CD的患儿，在入组时及食用GFD至少一年后，对其血液学指标进行前瞻性评估。将结果与年龄和性别匹配的对照组进行比较。血液学指标评估包括血红蛋白测定、全血细胞计数、外周血涂片检查、血清铁、总铁结合力（TIBC）和血清铁蛋白测定。所有入组病例在饮食中排除麸质的同时给予铁剂补充。在完成1年GFD饮食后，对所有病例进行重复肠道活检。
对21例诊断为CD且完成至少1年GFD常规随访（平均1.5年，范围1 - 2年）的患儿，在入组时以及食用GFD并补充铁剂后分析其血液学指标。入组时，所有患儿血红蛋白水平<11 g/dl，78%有小细胞低色素性贫血，22%有双相性贫血，与对照组相比，平均MCV、MCH和血清铁蛋白水平较低，平均TIBC显著较高（p<0.001）。在对这些进行GFD饮食的病例的随访评估中，平均血红蛋白水平与对照组相当，但病例的平均MCV、MCH血清铁蛋白水平仍较低（p<0.05），平均TIBC较高（p<0.05）。7例患儿有轻度贫血。血清铁蛋白水平与绒毛萎缩程度和固有层浸润呈负相关。
我们的结果表明，缺铁性贫血（IDA）常与CD相关，即使在饮食中排除麸质并补充铁剂后，缺铁状态仍会持续较长时间。除了为他们提供富含铁的GFD饮食外，早期发现和治疗IDA以及预防性补充铁叶酸对优化他们的智力和精神运动功能大有帮助。
