Butterworth J R, Iqbal T H, Cooper B T
Gastroenterology Unit, City Hospital, Birmingham, UK.
Eur J Gastroenterol Hepatol. 2005 May;17(5):541-5. doi: 10.1097/00042737-200505000-00011.
The catchment population of our hospital is ethnically diverse and we have seen a number of patients of South Asian origin with coeliac disease. We have suspected that there are differences compared with white Caucasian coeliacs, especially with respect to iron-deficiency anaemia and vitamin D deficiency at presentation.
To compare the clinical and laboratory features of South Asian adult coeliac patients with adult white Caucasian coeliacs.
We reviewed the notes of patients attending the adult coeliac clinic over the past 10 years. All patients were older than 16 years at diagnosis. There were 40 South Asians and 90 white Caucasians. Symptoms, haematology, biochemistry, endomysial antibody status, HLA alleles and small bowel histology at presentation were compared between the two racial groups.
There were significant differences between the racial groups. South Asians were younger at presentation than the Caucasian patients (mean age 27 years compared with 47 years respectively, P<0.0001); they were less likely to have 'irritable bowel syndrome' symptoms (P<0.01), but more likely to have features of vitamin D deficiency (P<0.03). Their haemoglobin (P<0.05), mean cell volume (P<0.0004), serum iron (P<0.01), transferrin saturation (P<0.05), serum 1,25-dihydroxyvitamin D3 (P<0.002), and levels were lower, while serum alkaline phosphatase levels were higher (P<0.04) than in white Caucasian coeliac patients. There were no differences with respect to serum folate, vitamin B12, serum calcium, alanine aminotransferase and small bowel histology. IgA class endomysial antibody positivity was similar in the two groups (88.5% for South Asians compared with 73.5% for white Caucasians). White Caucasian patients were significantly more likely to be DQ2-positive than the South Asian patients (97.2% compared with 83.3%, P=0.02).
South Asians with coeliac disease are less likely to present with 'irritable bowel syndrome' symptoms, but more likely to have features of vitamin D deficiency and iron deficiency, and have a higher alkaline phosphatase than white Caucasians. The differences in HLA alleles seen in South Asians with coeliac disease compared with white Caucasian patients suggests that among the South Asians, non-HLA regions may play a stronger role in disease susceptibility and presentation.
我院的服务人群种族多样，我们诊治了一些南亚裔乳糜泻患者。我们怀疑这些患者与白种乳糜泻患者存在差异，尤其是在就诊时缺铁性贫血和维生素D缺乏方面。
比较成年南亚裔乳糜泻患者与成年白种乳糜泻患者的临床和实验室特征。
我们回顾了过去10年在成人乳糜泻门诊就诊患者的病历。所有患者诊断时年龄均超过16岁。其中有40名南亚裔患者和90名白种患者。比较了两个种族组在就诊时的症状、血液学、生物化学、肌内膜抗体状态、HLA等位基因和小肠组织学情况。
两个种族组之间存在显著差异。南亚裔患者就诊时比白种患者年轻（平均年龄分别为27岁和47岁，P<0.0001）；他们出现“肠易激综合征”症状的可能性较小（P<0.01），但出现维生素D缺乏特征的可能性较大（P<0.03）。他们的血红蛋白（P<0.05）、平均红细胞体积（P<0.0004）、血清铁（P<0.01）、转铁蛋白饱和度（P<0.05）、血清1,25 - 二羟维生素D3（P<0.002）水平较低，而血清碱性磷酸酶水平较高（P<0.04），均低于白种乳糜泻患者。在血清叶酸、维生素B12、血清钙、丙氨酸转氨酶和小肠组织学方面无差异。两组中IgA类肌内膜抗体阳性率相似（南亚裔为88.5%，白种人为73.5%）。白种患者DQ2阳性的可能性显著高于南亚裔患者（97.2%比83.3%，P = 0.02）。
患有乳糜泻的南亚裔患者出现“肠易激综合征”症状的可能性较小，但出现维生素D缺乏和缺铁特征的可能性较大，且碱性磷酸酶水平高于白种人。与白种乳糜泻患者相比，南亚裔乳糜泻患者中HLA等位基因的差异表明，在南亚裔人群中，非HLA区域在疾病易感性和临床表现中可能起更强的作用。
