Cantarero Vallejo M D, Gómez Camarero J, Menchén L, Pajares Díaz J A, Lo Iacono O
Consulta de Pediatría de AP. Centro de Salud de Illescas, Toledo.
Rev Esp Enferm Dig. 2007 Nov;99(11):648-52. doi: 10.4321/s1130-01082007001100005.
Celiac disease (CD) is an important cause of serum aminotransferase elevation: between 5 and 10% of patients with persistent and cryptogenetic transaminase elevation may have CD. In fact, a wide spectrum of liver injuries in children and adults may be related to CD, particularly: a) mild parenchymal damage characterized by absence of any clinical signs or symptoms suggesting chronic liver disease, and by non-specific histological changes reversible on a gluten-free diet; b) chronic liver damage with autoimmune etiology, including autoimmune hepatitis, primary sclerosing cholangitis, and primary biliary cirrhosis, which may be associated with CD but are generally unaffected by gluten withdrawal; and c) severe liver failure and decompensated cryptogenetic liver cirrhosis, potentially treatable with a gluten-free diet. Such different types of liver injuries may represent one same disorder where individual factors, such as genetic predisposition, precocity, and duration of exposure to gluten may influence reversibility of liver damage. A rigorous cross-checking for asymptomatic liver damage in CD individuals and, conversely, for CD in any cryptogenic liver disorder, including end-stage liver failure, is recommended.
乳糜泻（CD）是血清转氨酶升高的一个重要原因：在持续性和原因不明的转氨酶升高患者中，有5%至10%可能患有CD。事实上，儿童和成人中广泛的肝脏损伤可能与CD有关，特别是：a）轻度实质损伤，其特征是没有任何提示慢性肝病的临床体征或症状，且组织学变化不具特异性，在无麸质饮食后可逆转；b）具有自身免疫病因的慢性肝损伤，包括自身免疫性肝炎、原发性硬化性胆管炎和原发性胆汁性肝硬化，这些可能与CD相关，但一般不受无麸质饮食的影响；c）严重肝衰竭和失代偿性原因不明的肝硬化，可能通过无麸质饮食治疗。这些不同类型的肝损伤可能代表同一种疾病，其中个体因素，如遗传易感性、早熟和接触麸质的持续时间，可能影响肝损伤的可逆性。建议对CD个体的无症状肝损伤进行严格的交叉检查，反之，对任何原因不明的肝脏疾病（包括终末期肝衰竭）中的CD进行检查。
