Iuorio R, Mercuri V, Barbarulo F, D'Amico T, Mecca N, Bassotti G, Pietrobono D, Gargiulo P, Picarelli A
Department of Clinical Sciences, Policlinico Umberto I, University 'La Sapienza', Rome, Italy.
Minerva Endocrinol. 2007 Dec;32(4):239-43.
Many autoimmune disorders are associated to celiac disease (CD) but the association with autoimmune thyroiditis has been more frequently documented; this is in part explained by a shared immunogenetic make-up, and in part caused to time gluten-exposition, as suggested by the significant correlation observed in celiac patients between the increase occurrence of autoimmune diseases and the length of exposure to gluten. The aim of this study was to establish the prevalence of celiac disease in a group of subjects with autoimmune thyroiditis newly diagnosed on the basis of antibodies anti-peroxidase (TPO).
A total of 113 untreated patients with TPO >70 IU/mL were enrolled. CD was screened by measuring anti-endomysial antibodies (EMA) both IgA and IgG; an high prevalence of positive serology was resulting in this group, justified, in part, from EMA IgG investigation.
In fact 31/113 patients showed IgA and/or IgG positivity and were diagnosed as celiacs with jejunal biopsy.
On the basis of this paper, such as in according to current research-setting studies, the greater frequency of CD in association to autoimmune thyroid disease suggests that all subjects with TPO should be routinely screened for CD, through EMA IgA and IgG. However, the performance of this screening has never been evaluated until now, even if it could, in fact, be valid in order to increment diagnosis of CD, today still undiagnosed.
许多自身免疫性疾病与乳糜泻(CD)相关,但与自身免疫性甲状腺炎的关联记录更为频繁;这部分归因于共同的免疫遗传构成,部分归因于麸质暴露时间,这从乳糜泻患者自身免疫性疾病发生率增加与麸质暴露时长之间观察到的显著相关性中可见一斑。本研究的目的是确定一组基于抗过氧化物酶(TPO)抗体新诊断出的自身免疫性甲状腺炎患者中乳糜泻的患病率。
共纳入113例未经治疗且TPO>70 IU/mL的患者。通过检测抗肌内膜抗体(EMA)的IgA和IgG来筛查CD;该组血清学阳性率较高,部分原因在于对EMA IgG的检测。
实际上,31/113例患者显示IgA和/或IgG阳性,并经空肠活检确诊为乳糜泻。
基于本文以及当前的研究设定,CD与自身免疫性甲状腺疾病关联的较高频率表明,所有TPO阳性的患者都应通过EMA IgA和IgG对CD进行常规筛查。然而,这种筛查的效果至今尚未得到评估,即便它实际上可能有助于提高CD的诊断率,而目前CD仍有许多未被诊断出来。