Freeman Hugh J
Department of Medicine (Gastroenterology), University of British Columbia, Vancouver, BC.
J Clin Gastroenterol. 2008 Mar;42(3):252-5. doi: 10.1097/MCG.0b013e31802e70a1.
Celiac disease has been associated with autoimmune disease (eg, autoimmune thyroiditis) and the appearance of different autoantibodies (eg, antidouble-stranded DNA). Conversely, tissue transglutaminase antibodies have been detected in autoimmune disorders, including systemic lupus erythematosus (SLE), but cases of celiac disease with SLE have been only rarely recorded.
In this study, 246 patients with biopsy-defined celiac disease were evaluated for a prior diagnosis of SLE on the basis of American Rheumatological Association-defined clinical and serologic parameters.
There were 6 patients with celiac disease and SLE, or 2.4%, including 4 females and 2 males. Their mean age at diagnosis of celiac disease was 44.7 years and SLE 50 years. In all patients, the diagnosis of SLE was established from 2 years to more than 10 years after the diagnosis of celiac disease, with a mean of 5.3 years. The celiac disease in all 6 patients responded to a gluten-free diet with histologic normalization of the small intestinal biopsies. Despite this small bowel biopsy response, SLE appeared later in the clinical course of the celiac disease.
This study suggests that SLE occurs far more frequently in biopsy-defined celiac disease than is currently appreciated, and detection may be more likely if the period of clinical follow-up of the celiac disease is prolonged.
乳糜泻与自身免疫性疾病（如自身免疫性甲状腺炎）及不同自身抗体（如抗双链DNA）的出现有关。相反，在包括系统性红斑狼疮（SLE）在内的自身免疫性疾病中已检测到组织转谷氨酰胺酶抗体，但乳糜泻合并SLE的病例仅有少数报道。
在本研究中，根据美国风湿病学会定义的临床和血清学参数，对246例经活检确诊为乳糜泻的患者进行了SLE既往诊断评估。
有6例乳糜泻合并SLE患者，占2.4%，其中4例女性，2例男性。他们诊断乳糜泻时的平均年龄为44.7岁，诊断SLE时的平均年龄为50岁。所有患者中，SLE的诊断在乳糜泻诊断后2年至10年以上确立，平均为5.3年。所有6例患者的乳糜泻对无麸质饮食有反应，小肠活检组织学恢复正常。尽管小肠活检有反应，但SLE在乳糜泻临床病程中出现较晚。
本研究表明，活检确诊的乳糜泻患者中SLE的发生率远比目前认为的要高，如果延长乳糜泻的临床随访时间，可能更易检测到。
