Killander Anna, Arnell Henrik, Hagenäs Lars, Finkel Yigael
Department of Women and Child Health, Karolinska Institutet, Stockholm Sweden.
Acta Paediatr. 2007 Aug;96(8):1190-4. doi: 10.1111/j.1651-2227.2007.00382.x. Epub 2007 Jun 18.
To evaluate the practice of diagnosing coeliac disease with only one small-bowel mucosal biopsy in a selected group of children with suspected coeliac disease.
A retrospective review of medical records and a follow-up interview of 102 children (65 girls, 37 boys) at diagnosis of coeliac disease. The inclusion criteria were age >18 months, increased levels of serum antitissue transglutaminase IgA antibodies and pathologic small-bowel mucosal biopsy. Anthropometric data were calculated for children 1.5-11 years of age.
The levels of serum antitissue transglutaminase IgA antibodies were either normal (92%) or slightly elevated (8%) in all children after 1 year on a gluten-free diet. The height-for-age Z score increased in 52 of 61 (85%) children, (median 0.26 SD, range -0.45 to 1.83 SD) and the weight-for-age Z score increased in 50 of 61 (82%) children (median 0.42 SD, range -0.77 to 2.24 SD). Sixty of 61 (98%) children showed normal or catch-up growth. Regression of symptoms after 1 year on a gluten-free diet was reported for 71 of 72 (98%) children.
We propose that a control biopsy is not necessary for the diagnosis of coeliac disease in these children.
评估在一组疑似乳糜泻的儿童中仅通过一次小肠黏膜活检诊断乳糜泻的实践情况。
对102例乳糜泻诊断儿童（65名女孩，37名男孩）的病历进行回顾性分析，并进行随访访谈。纳入标准为年龄>18个月、血清抗组织转谷氨酰胺酶IgA抗体水平升高以及小肠黏膜活检病理异常。计算了1.5至11岁儿童的人体测量数据。
所有儿童在无麸质饮食1年后，血清抗组织转谷氨酰胺酶IgA抗体水平正常（92%）或轻度升高（8%）。61名儿童中有52名（85%）年龄别身高Z评分增加（中位数0.26标准差，范围-0.45至1.83标准差），61名儿童中有50名（82%）年龄别体重Z评分增加（中位数0.42标准差，范围-0.77至2.24标准差）。61名儿童中有60名（98%）生长正常或实现追赶生长。72名儿童中有71名（98%）报告在无麸质饮食1年后症状消退。
我们建议对这些儿童诊断乳糜泻时无需进行对照活检。
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