Bardella M T, Velio P, Cesana B M, Prampolini L, Casella G, Di Bella C, Lanzini A, Gambarotti M, Bassotti G, Villanacci V
Department of Gastroenterology and Endocrine Diseases, Fondazione IRCCS, Ospedale Maggiore Policlinico, Mangialli and Regina Elena, Milano, Italy.
Histopathology. 2007 Mar;50(4):465-71. doi: 10.1111/j.1365-2559.2007.02621.x.
To assess the histological response to a gluten-free diet (GFD) in a series of coeliac patients in clinical remission, of different ages and with varying degrees of mucosal damage at diagnosis.
Biopsy samples from 249 coeliac patients (F 165, M 84) were analysed basally and after clinical and biochemical remission following a GFD. All patients showed an improvement in mucosal findings after starting a GFD, but complete histological normalization was observed in 74.1% of paediatric cases (diagnosed before 14 years of age) and in only 17.5% of adults. Statistical analysis showed that sex, the clinical picture at diagnosis and the length of time between biopsy at the time of diagnosis and on a GFD were not related to histological normalization. In contrast, the age at diagnosis was statistically significantly related to it (P < 0.0001). In addition, the presence/absence of Helicobacter pylori was independent of the normalization of the duodenal mucosa.
In clinical practice the criteria for diagnosis of coeliac disease are sufficiently standardized, whereas for follow-up they are less well defined. We suggest that in order to compare the results from different studies, it should be stated whether remission after treatment is based on clinical or histological criteria or both.
评估一系列处于临床缓解期、年龄不同且诊断时黏膜损伤程度各异的乳糜泻患者对无麸质饮食（GFD）的组织学反应。
对249例乳糜泻患者（女性165例，男性84例）的活检样本进行了基线分析，并在采用GFD实现临床和生化缓解后再次分析。所有患者在开始GFD后黏膜表现均有改善，但在74.1%的儿科病例（14岁之前确诊）中观察到组织学完全正常化，而在成人中这一比例仅为17.5%。统计分析表明，性别、诊断时的临床表现以及诊断时活检与采用GFD时活检之间的时间间隔与组织学正常化无关。相比之下，诊断时的年龄与之具有显著统计学相关性（P < 0.0001）。此外，幽门螺杆菌的存在与否与十二指肠黏膜的正常化无关。
在临床实践中，乳糜泻的诊断标准已足够标准化，而随访标准则不够明确。我们建议，为了比较不同研究的结果，应说明治疗后的缓解是基于临床标准、组织学标准还是两者兼有。
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