Collin Pekka, Wahab Peter J, Murray Joseph Anthony
Tampere University Hospital and University of Tampere, University of Tampere, FIN-33014 Tampere, Finland.
Best Pract Res Clin Gastroenterol. 2005 Jun;19(3):341-50. doi: 10.1016/j.bpg.2005.01.005.
The diagnosis of coeliac disease is easy in cases with symptoms and unequivocal small intestinal villous atrophy. However, patients often suffer from only subtle if any symptoms. Borderline villous shortening is common, making the histologic diagnosis difficult. The increase in intraepithelial lymphocytes is typical even in early-stage untreated coeliac disease. Unfortunately, this finding is unspecific. In coeliac disease, the relative density of gammadelta+ intraepithelial lymphocytes is increased. The presence of IgA class anti-endomysium or anti-tissue transglutaminase antibodies clearly increases the likelihood of the disease. Coeliac disease is closely linked to HLA DQ2 and DQ8, and their absence speaks strongly against the condition, whereas a positive finding is virtually of no diagnostic value. In borderline cases, the gluten-dependency of symptoms or mucosal inflammation should be shown by gluten-free diet or gluten challenge. No single test is efficient enough to distinguish unspecific increase in intraepithelial lymphocytes from early coeliac disease; clinical history, histology, serology and gluten-dependency should be taken into account in the diagnostic work-up.
对于有症状且小肠绒毛萎缩明确的乳糜泻病例，其诊断较为容易。然而，患者通常仅有轻微症状，甚至没有症状。临界性绒毛缩短很常见，这使得组织学诊断困难。即使在未经治疗的早期乳糜泻中，上皮内淋巴细胞增多也是典型表现。不幸的是，这一发现并不具有特异性。在乳糜泻中，γδ+上皮内淋巴细胞的相对密度增加。IgA类抗肌内膜或抗组织转谷氨酰胺酶抗体的存在明显增加了该病的可能性。乳糜泻与HLA DQ2和DQ8密切相关，不存在这两种基因强烈提示排除该病，而阳性结果实际上并无诊断价值。在临界病例中，应通过无麸质饮食或麸质激发试验来证明症状或黏膜炎症对麸质的依赖性。没有单一的检测方法足以区分上皮内淋巴细胞的非特异性增多与早期乳糜泻；在诊断过程中应综合考虑临床病史、组织学、血清学及麸质依赖性。
