Brar P, Kwon G Y, Egbuna I I, Holleran S, Ramakrishnan R, Bhagat G, Green P H R
Department of Medicine, Pediatrics and Pathology, Columbia University College of Physicians and Surgeons, New York, NY 10032, USA.
Dig Liver Dis. 2007 Jan;39(1):26-9; discussion 30-2. doi: 10.1016/j.dld.2006.07.014. Epub 2006 Sep 18.
Both the clinical presentation and the degree of mucosal damage in coeliac disease vary greatly. In view of conflicting information as to whether the mode of presentation correlates with the degree of villous atrophy, we reviewed a large cohort of patients with coeliac disease.
We correlated mode of presentation (classical, diarrhoea predominant or atypical/silent) with histology of duodenal biopsies and examined their trends over time.
The cohort consisted of 499 adults, mean age 44.1 years, 68% females. The majority had silent coeliac disease (56%) and total villous atrophy (65%). There was no correlation of mode of presentation with the degree of villous atrophy (p=0.25). Sixty-eight percent of females and 58% of males had a severe villous atrophy (p=0.052). There was a significant trend over time for a greater proportion of patients presenting as atypical/silent coeliac disease and having partial villous atrophy, though the majority still had total villous atrophy.
Among our patients the degree of villous atrophy in duodenal biopsies did not correlate with the mode of presentation, indicating that factors other than the degree of villous atrophy must account for diarrhoea in coeliac disease.
乳糜泻的临床表现和黏膜损伤程度差异很大。鉴于关于临床表现方式是否与绒毛萎缩程度相关的信息相互矛盾，我们对一大群乳糜泻患者进行了回顾性研究。
我们将临床表现方式（典型、腹泻为主型或非典型/隐匿型）与十二指肠活检组织学结果进行关联，并研究其随时间的变化趋势。
该队列包括499名成年人，平均年龄44.1岁，女性占68%。大多数患者为隐匿型乳糜泻（56%），且存在完全性绒毛萎缩（65%）。临床表现方式与绒毛萎缩程度无相关性（p = 0.25）。68%的女性和58%的男性存在严重绒毛萎缩（p = 0.052）。随着时间推移，呈现非典型/隐匿型乳糜泻且伴有部分绒毛萎缩的患者比例有显著上升趋势，尽管大多数患者仍为完全性绒毛萎缩。
在我们的患者中，十二指肠活检的绒毛萎缩程度与临床表现方式无关，这表明乳糜泻患者腹泻的原因必定是绒毛萎缩程度以外的其他因素。
