大额：未确诊乳糜泻的一种新体征。

Large forehead: a novel sign of undiagnosed coeliac disease.

作者信息

Finizio M, Quaremba G, Mazzacca G, Ciacci C

机构信息

Dental School, Chair of Dental and Biomedical Informatics, Second University of Napoli, Naples, Italy.

出版信息

Dig Liver Dis. 2005 Sep;37(9):659-64. doi: 10.1016/j.dld.2005.04.014.

DOI:10.1016/j.dld.2005.04.014

PMID:15919249

Abstract

BACKGROUND

The development of cranial proportions is the result of genetic, embriogenetic and environmental factors. Coeliac disease is a genetically inherited disease that is frequently diagnosed in adulthood in individuals, in whom the disease runs unidentified for years and can affect child growth from the moment of dietary gluten introduction up to the moment of gluten withdrawal following diagnosis. Data on the effects of gluten on craniofacial development in coeliac children are not available.

AIM

The aim of the present study is to evaluate gluten-related effects on face development in patients with undiagnosed coeliac disease and their clinical relevance.

METHODS

The study was a prospective, multivariate analysis. Face photographs of adult patients with coeliac disease and healthy controls were marked at six reference points and distances and the ratios among distances were measured by computer program software.

RESULTS

The main finding of the study is that Caucasian Mediterranean adult coeliac individuals tend to have a peculiar aspect of the face characterised by a larger forehead when compared to general population controls.

CONCLUSION

The craniofacial morphology of patients with coeliac disease reveals an altered pattern of craniofacial growth. This is the first report of alterations of craniofacial development in coeliac disease. This alteration is a clinical sign that should be included among the extraintestinal manifestation of coeliac disease. It has a frequency comparable to other signs or symptoms such as anaemia and short stature and is a better predictor of coeliac disease than other signs such as recurrent aphthous stomatitis, recurrent abortion and dental enamel hypoplasia. A large forehead is a sign easily evident visually or with very simple measurements; computer analysis is not required for the general practitioner. This sign along with the presence of other clinical signs and symptoms, should alert a physician to test a patient for coeliac disease.

摘要

背景

颅骨比例的发育是遗传、胚胎发育和环境因素共同作用的结果。乳糜泻是一种遗传性疾病，常在成年期被诊断出来，患病个体在多年内未被确诊，从饮食中引入麸质到诊断后停止摄入麸质这段时间内，该病会影响儿童生长。目前尚无关于麸质对乳糜泻患儿颅面发育影响的数据。

目的

本研究旨在评估未确诊的乳糜泻患者中麸质对面部发育的影响及其临床相关性。

方法

本研究为前瞻性多变量分析。对成年乳糜泻患者和健康对照的面部照片标记六个参考点和距离，并通过计算机程序软件测量距离之间的比例。

结果

该研究的主要发现是，与一般人群对照相比，高加索地中海成年乳糜泻患者往往面部特征特殊，前额较大。

结论

乳糜泻患者的颅面形态显示颅面生长模式改变。这是关于乳糜泻患者颅面发育改变的首次报道。这种改变是一种临床体征，应纳入乳糜泻的肠外表现之中。其出现频率与贫血和身材矮小等其他体征或症状相当，并且比复发性口腔溃疡、复发性流产和牙釉质发育不全等其他体征更能预测乳糜泻。前额较大是一种在视觉上或通过非常简单的测量就能轻易发现的体征；全科医生无需进行计算机分析。这个体征连同其他临床体征和症状的出现，应提醒医生对患者进行乳糜泻检测。