成年乳糜泻患儿：童年期仅数年无麸质饮食的影响。

Grown-up coeliac children: the effects of only a few years on a gluten-free diet in childhood.

作者信息

Ciacci C, Iovino P, Amoruso D, Siniscalchi M, Tortora R, Di Gilio A, Fusco M, Mazzacca G

机构信息

Gastrointestinal Unit, Federico II University of Napoli, Naples, Italy.

出版信息

Aliment Pharmacol Ther. 2005 Feb 15;21(4):421-9. doi: 10.1111/j.1365-2036.2005.02345.x.

DOI:10.1111/j.1365-2036.2005.02345.x

PMID:15709993

Abstract

AIM

To evaluate clinical and psychological status of adults with childhood diagnosis of coeliac disease who were re-exposed to gluten after only a few years and now on a gluten-containing diet, compared with adults with recent diagnosis of coeliac disease, and adults who remained on gluten-free diet after childhood diagnosis.

METHODS

A total of 195 adults with a biopsy suggestive of coeliac disease in childhood, who either had adhered to a gluten-free diet for at least 1 year after diagnosis and now are either on gluten-free diet (n = 110) or on gluten-containing diet (n = 85), and adults with newly diagnosed coeliac disease (n = 165) underwent a medical check-up.

RESULTS

Body mass index and main laboratory indices were statistically different among groups (lowest in never on gluten-free diet, highest in gluten-free diet). The lowest average levels of bone mineral density were found among never on gluten-free diet patients. Prevalence of autoimmune disorders was increased in never on gluten-free diet when compared with the transient gluten-free diet and gluten-free diet groups. Histology revealed villous subatrophy in all patients of never on gluten-free diet group, in 39 of 110 patients of gluten-free diet and in 84 of 85 of transient gluten-free diet groups. Herpetiform dermatitis was found in three patients of gluten-free diet, three of transient gluten-free diet and three of never on gluten-free diet. Dental enamel defects were found in 15 patients of transient gluten-free diet, 43 of never on gluten-free diet and in zero of the gluten-free diet group. Pregnancy outcome was not significantly different between the two groups, but neonatal weight was lower and breast feeding was shorter in the never on gluten-free diet group. Sexual habits, alcohol intake and cigarette smoking were significantly different in the never on gluten-free diet group when compared with the other two groups.

CONCLUSION

Gluten withdrawal in childhood partly protects coeliac adults from clinical and behavioural effects of gluten sensitivity.

摘要

目的

评估童年期诊断为乳糜泻、仅几年后重新接触麸质且目前采用含麸质饮食的成年人的临床和心理状况，并与近期诊断为乳糜泻的成年人以及童年期诊断后一直采用无麸质饮食的成年人进行比较。

方法

共有195名童年期活检提示乳糜泻的成年人接受了医学检查，这些人在诊断后至少坚持无麸质饮食1年，目前要么仍采用无麸质饮食（n = 110），要么采用含麸质饮食（n = 85），还有新诊断为乳糜泻的成年人（n = 165）。

结果

各组之间的体重指数和主要实验室指标存在统计学差异（从未采用无麸质饮食组最低，无麸质饮食组最高）。从未采用无麸质饮食的患者骨矿物质密度平均水平最低。与短暂无麸质饮食组和无麸质饮食组相比，从未采用无麸质饮食组自身免疫性疾病的患病率有所增加。组织学检查显示，从未采用无麸质饮食组的所有患者、无麸质饮食组110名患者中的39名以及短暂无麸质饮食组85名患者中的84名均有绒毛亚萎缩。无麸质饮食组的3名患者、短暂无麸质饮食组的3名患者和从未采用无麸质饮食组的3名患者发现有疱疹样皮炎。短暂无麸质饮食组的15名患者、从未采用无麸质饮食组的43名患者发现有牙釉质缺陷，无麸质饮食组未发现。两组的妊娠结局无显著差异，但从未采用无麸质饮食组的新生儿体重较低，母乳喂养时间较短。与其他两组相比，从未采用无麸质饮食组的性行为习惯、酒精摄入量和吸烟情况有显著差异。