Lo Iacono Oreste, Petta Salvatore, Venezia Giovanna, Di Marco Vito, Tarantino Giuseppe, Barbaria Francesco, Mineo Claudia, De Lisi Stefania, Almasio Piero Luigi, Craxì Antonio
University of Palermo, Gastroenterology and Hepatology Unit, Palermo, Italy.
Am J Gastroenterol. 2005 Nov;100(11):2472-7. doi: 10.1111/j.1572-0241.2005.00244.x.
Coeliac disease (CD) is found in 5-10% of patients with chronically abnormal liver tests and no obvious cause of liver disease. In this population the efficacy of screening for CD by anti-tissue transglutaminase (anti-tTG) may be impaired by the high rate of positive anti-tTG found in chronic liver disease.
To evaluate the prevalence of coeliac disease and the role of anti-tTG in patients with non-viral, non-autoimmune chronic and no obvious cause of liver damage.
Out of 2,512 consecutive patients with abnormal liver tests, 168 (118 men, 50 women; mean age 40.7 +/- 12.6 years) were defined, on the basis of clinical data and liver biopsy, as NAFLD or cryptogenic chronic hepatitis. All were tested by recombinant IgA and IgG anti-tissue transglutaminase. Patients with a positive serology underwent endoscopy with duodenal biopsies.
NAFLD was diagnosed in 121 patients, in 6 associated with cirrhosis, while 47 patients were considered as cryptogenic hepatitis in the absence of steatosis. Anti-tTG were positive in 20/168 patients (3 IgA alone; 11 IgG alone; 6 both IgA and IgG). Coeliac disease was found at endoscopy and confirmed by histopathology only in the 6 patients (3.6%) with both IgA and IgG anti-tTG positivity. Four of the patients with CD had NAFLD (3.3%), in 2 of them associated with cirrhosis; while 2 of those with cryptogenic hepatitis (4.2%) had CD.
The prevalence of CD in patients with chronically abnormal liver tests of unexplained etiology is 4%, with no relation with the degree of liver steatosis. Screening should be done by testing for IgA and IgG antibodies and then evaluating by endoscopy and biopsy only patients positive for both.
在慢性肝功能检查异常且无明显肝病病因的患者中，乳糜泻（CD）的发生率为5% - 10%。在这一人群中，慢性肝病患者抗组织转谷氨酰胺酶（抗-tTG）检测呈阳性的比例较高，可能会影响通过抗-tTG筛查CD的效果。
评估非病毒性、非自身免疫性慢性肝病且无明显肝损伤病因患者中乳糜泻的患病率以及抗-tTG的作用。
在2512例连续肝功能检查异常的患者中，根据临床资料和肝活检，168例（118例男性，50例女性；平均年龄40.7±12.6岁）被定义为非酒精性脂肪性肝病（NAFLD）或隐源性慢性肝炎。所有患者均接受重组IgA和IgG抗组织转谷氨酰胺酶检测。血清学检测呈阳性的患者接受十二指肠活检的内镜检查。
121例患者被诊断为NAFLD，其中6例合并肝硬化，而47例患者在无脂肪变性的情况下被视为隐源性肝炎。168例患者中有20例抗-tTG呈阳性（3例仅IgA阳性；11例仅IgG阳性；6例IgA和IgG均阳性）。仅在6例（3.6%）IgA和IgG抗-tTG均呈阳性的患者中，通过内镜检查发现并经组织病理学证实为乳糜泻。4例CD患者患有NAFLD（3.3%），其中2例合并肝硬化；而2例（4.2%）隐源性肝炎患者患有CD。
病因不明的慢性肝功能检查异常患者中CD的患病率为4%，与肝脏脂肪变性程度无关。筛查应通过检测IgA和IgG抗体进行，然后仅对两者均呈阳性的患者进行内镜检查和活检评估。
