Betterle Corrado, Lazzarotto Francesca, Spadaccino Aglaura Cinzia, Basso Daniela, Plebani Mario, Pedini Beniamino, Chiarelli Silvia, Albergoni Mariapaola
Division of Endocrinology, Department of Medical and Surgical Sciences, University of Padua Medical School, Via Ospedale Civile 105, 35100 Padua, Italy.
Eur J Endocrinol. 2006 Feb;154(2):275-9. doi: 10.1530/eje.1.02089.
Patients with autoimmune Addison's disease (AAD) are prone to develop other autoimmune manifestations. An increased prevalence of celiac disease (CD) has recently been demonstrated in Northern European patients with AAD. IgA deficiency is the most frequent type of immunodeficiency among humans and is present in about one in every 600 individuals in the population. IgA deficiency is frequent in patients with other autoimmune diseases, but data concerning AAD are still unavailable.
The aim was to define the prevalence of CD and of IgA deficiency in a group of Italian patients with AAD.
One hundred and nine patients with AAD were enrolled and examined for tissue transglutaminase autoantibodies of the IgA class, circulating levels of IgA and adrenal cortex antibodies.
Two (1.8%) of the patients were affected by already diagnosed CD and were already on a gluten-free diet. Out of the remaining 107 patients, four (3.7%) were found to be positive for IgA antibodies to human tissue transglutaminase. Three of the four patients who were positive for tissue transglutaminase autoantibodies agreed to undergo endoscopy and duodenal biopsies and, in one, a latent form of CD was identified. The clinical, silent or latent form of CD was present in six out of 109 (5.4%). This prevalence was significantly higher (P = 0.0001) than that reported for the Northern Italian population which was equal to 0.063%. Specifically, CD was present in 12.5% of the autoimmune polyglandular syndrome (APS) type 1 cases, in four out of 60 (6.7%) of the APS type 2 cases and in one out of 40 (2.5%) of the isolated AAD cases. IgA deficiency was present in two out of 109 patients (1.8%), all of whom had normal IgG anti-gliadin. Autoantibodies to the adrenal cortex were detected in 81 out of 109 patients (74.3%).
In patients with AAD there is a high prevalence of both CD and IgA deficiency. Consequently, it is important to screen for CD with tissue transglutaminase autoantibodies of the IgA class and for IgA levels.
自身免疫性艾迪生病（AAD）患者容易出现其他自身免疫表现。最近在北欧AAD患者中已证实乳糜泻（CD）患病率增加。IgA缺乏是人类中最常见的免疫缺陷类型，在人群中约每600人中有1人存在。IgA缺乏在其他自身免疫性疾病患者中很常见，但关于AAD的数据仍然缺乏。
目的是确定一组意大利AAD患者中CD和IgA缺乏的患病率。
招募109例AAD患者，并检测其IgA类组织转谷氨酰胺酶自身抗体、IgA循环水平和肾上腺皮质抗体。
2例（1.8%）患者已确诊患有CD且已采用无麸质饮食。在其余107例患者中，4例（3.7%）被发现针对人组织转谷氨酰胺酶的IgA抗体呈阳性。4例组织转谷氨酰胺酶自身抗体呈阳性的患者中有3例同意接受内镜检查和十二指肠活检，其中1例被确诊为隐匿型CD。109例中有6例（5.4%）存在临床型、无症状型或隐匿型CD。该患病率显著高于（P = 0.0001）意大利北部人群报告的患病率，后者为0.063%。具体而言，1型自身免疫性多腺体综合征（APS）病例中CD的患病率为12.5%，2型APS病例60例中有4例（6.7%），孤立性AAD病例40例中有1例（2.5%）。109例患者中有2例（1.8%）存在IgA缺乏，他们的IgG抗麦醇溶蛋白均正常。109例患者中有81例（74.3%）检测到肾上腺皮质自身抗体。
AAD患者中CD和IgA缺乏的患病率均较高。因此，用IgA类组织转谷氨酰胺酶自身抗体筛查CD以及检测IgA水平很重要。
