Vilela Eduardo Garcia, de Abreu Ferrari Maria de Lourdes, de Gama Torres Henrique Osvaldo, Martins Fabiana Paiva, Goulart Eugênio Marcos Andrade, Lima Agnaldo Soares, da Cunha Aloíso Sales
Instituto Alfa de Gastroenterologia do Hospital das Clínicas da Universidade Federal de Minas Gerais, Belo Horizonte, Brazil.
Dig Dis Sci. 2007 May;52(5):1304-9. doi: 10.1007/s10620-006-9511-8. Epub 2007 Mar 14.
Celiac disease causes chronic inflammation of the intestinal mucosa and reduces surface absorption; after the withdrawal of gluten from the diet, there are clinical and histologic improvements. The intestinal permeability test and serologic tests are useful for confirming the diagnosis and monitoring patients. The goal of this study is to compare the antigliadin antibody (AGA) test with the intestinal permeability test for celiac patients on a gluten-free diet. The sample consisted of 22 celiac patients who were antigliadin immunoglobulin A-positive before treatment. After 12 months on a gluten-free diet, AGA testing was repeated and the intestinal permeability test was performed. A control group was composed of 11 healthy individuals. AGA remained positive in 40.9% of celiac patients, and the mean urinary lactulose excretion was 10.27%, that of mannitol was 10.18%, and the lactulose/mannitol ratio was 1.02. In the subgroup in which antigliadin became negative (59.1%), the value for lactulose was 3.79%, that for mannitol was 11.12%, the lactulose/mannitol ratio was 0.38, and the p value was less than 0.0001, 0.66, and less than 0.0001, respectively. When the two celiac subgroups were compared with the control group, the urinary lactulose excretion and the lactulose/mannitol ratio was less in the control group, whereas urinary mannitol excretion was greater. The p values were less than 0.0001 for the three variables, suggesting persistent lesions in mucosa of both subgroups, although to a lesser degree for those that became AGA negative. It is concluded that intestinal permeability allows a more precise clinical physiopathologic correlation than antigliadin and offers more information for the monitoring of these patients.
乳糜泻会导致肠道黏膜慢性炎症并降低表面吸收能力；从饮食中去除麸质后，临床症状和组织学表现会有所改善。肠道通透性测试和血清学检测有助于确诊和监测患者。本研究的目的是比较无麸质饮食的乳糜泻患者的抗麦胶蛋白抗体（AGA）检测和肠道通透性测试。样本包括22名治疗前抗麦胶蛋白免疫球蛋白A呈阳性的乳糜泻患者。在进行12个月的无麸质饮食后，重复进行AGA检测并进行肠道通透性测试。对照组由11名健康个体组成。40.9%的乳糜泻患者AGA仍为阳性，尿乳糖排泄平均为10.27%，甘露醇为10.18%，乳糖/甘露醇比值为1.02。在抗麦胶蛋白转为阴性的亚组（59.1%）中，乳糖值为3.79%，甘露醇值为11.12%，乳糖/甘露醇比值为0.38，p值分别小于0.0001、0.66和小于0.0001。当将两个乳糜泻亚组与对照组进行比较时，对照组的尿乳糖排泄和乳糖/甘露醇比值较低，而尿甘露醇排泄较高。这三个变量的p值均小于0.0001，表明两个亚组的黏膜均存在持续性病变，尽管抗麦胶蛋白转为阴性的亚组病变程度较轻。研究得出结论，与抗麦胶蛋白相比，肠道通透性能实现更精确的临床病理生理关联，为这些患者的监测提供更多信息。
