Pyle Gail G, Paaso Brian, Anderson Barbara E, Allen Diane D, Marti Thomas, Li Qing, Siegel Matthew, Khosla Chaitan, Gray Gary M
Celiac Sprue Research Foundation, Palo Alto, California 94304-1193, USA.
Clin Gastroenterol Hepatol. 2005 Jul;3(7):687-94. doi: 10.1016/s1542-3565(05)00366-6.
BACKGROUND & AIMS: We sought to determine whether prolyl endopeptidase (PEP) treatment of food gluten would obviate the intestinal dysfunction produced by small amounts of dietary gluten supplement in patients with celiac sprue.
Twenty asymptomatic patients with histologically proven celiac sprue completed a randomized, double-blind, cross-over study involving two 14-day stages. Each patient consumed a low dose of a gluten supplement daily (5 g; equivalent to 1 slice of bread) in 1 stage and gluten pretreated with PEP in the other stage. Patients completed a daily symptom questionnaire and a D-xylose urine excretion and a 72-hour quantitative fecal fat were monitored before and after each stage.
Despite clinical remission at baseline, 40% of patients had at least 1 abnormal celiac antibody, 20% had an abnormal urine xylose, and 63% had an abnormal fecal fat test result. There was no difference in symptoms as a function of the type of gluten consumed. In response to gluten not treated with PEP, an appreciable proportion of patients developed malabsorption of fat (7 of 17, 41%) or xylose (8 of 14, 57%). When the gluten was pretreated with PEP, fat malabsorption was avoided in 5 of 7 and xylose malabsorption in 4 of 8 of these same patients.
A significant proportion of asymptomatic patients with celiac sprue have abnormal celiac antibodies and fat or carbohydrate malabsorption. Pretreatment of gluten with PEP avoided the development of fat or carbohydrate malabsorption in the majority of those patients who developed fat or carbohydrate malabsorption after a 2-week gluten challenge.
我们试图确定脯氨酰内肽酶（PEP）处理食物中的麸质是否能消除乳糜泻患者因摄入少量膳食麸质补充剂而产生的肠道功能障碍。
20名经组织学证实为乳糜泻的无症状患者完成了一项随机、双盲、交叉研究，该研究包括两个14天阶段。每位患者在一个阶段每天食用低剂量的麸质补充剂（5克；相当于1片面包），在另一个阶段食用经PEP预处理的麸质。患者每天完成症状问卷，并在每个阶段前后监测D-木糖尿排泄和72小时定量粪便脂肪。
尽管基线时临床缓解，但40%的患者至少有一种异常的乳糜泻抗体，20%的患者尿木糖异常，63%的患者粪便脂肪检测结果异常。食用不同类型麸质时症状无差异。对于未用PEP处理的麸质，相当一部分患者出现脂肪吸收不良（17例中的7例，41%）或木糖吸收不良（14例中的8例，57%）。当麸质用PEP预处理时，这些患者中有5例避免了脂肪吸收不良，8例中有4例避免了木糖吸收不良。
相当一部分无症状的乳糜泻患者有异常的乳糜泻抗体以及脂肪或碳水化合物吸收不良。在为期2周的麸质激发试验后出现脂肪或碳水化合物吸收不良的大多数患者中，用PEP预处理麸质可避免脂肪或碳水化合物吸收不良的发生。
