Högberg Lotta, Danielsson Lars, Jarleman Stefan, Sundqvist Tommy, Stenhammar Lars
Department of Paediatrics, Linköping University, Norrköping Hospital, Norrköping, Sweden.
Acta Paediatr. 2009 Feb;98(2):343-5. doi: 10.1111/j.1651-2227.2008.01085.x. Epub 2008 Oct 29.
In coeliac disease (CD) there is a gluten-induced small bowel enteropathy leading to malabsorption of various nutrients, vitamins and trace elements. Low levels of serum zinc have been reported in adults with untreated CD. In the present study we related the serum concentration of zinc to the morphology of the small bowel mucosa in 58 children, all under 4 years of age and under investigation for coeliac disease. The mean serum concentration of zinc (mean +/- SD; mumol/L) was significantly lower in children with untreated CD (9.7 +/- 2.0) (n = 11) compared to non-coeliac children without enteropathy (15.1 +/- 2.3) (n = 16) (p < 0.001), coeliac children on a gluten-free diet without enteropathy (14.2 +/- 1.6) (n = 14) (p < 0.001), coeliac children on gluten challenge with enteropathy (14.1 +/- 2.1) (n = 12) (p < 0.001) and coeliac children on gluten challenge without enteropathy (13.8 +/- 1.9) (n = 6) (p < 0.005).
Serum zinc concentration is decreased in untreated coeliac children with enteropathy and normalizes on gluten-free diet. A low serum zinc value in a child being investigated for possible CD on clinical grounds can thus be used as a complementary marker for enteropathy indicating further investigation with small bowel biopsy. The hypothetical role of zinc in the pathogenesis of CD is discussed.
在乳糜泻（CD）中，存在麸质诱导的小肠肠病，导致各种营养素、维生素和微量元素吸收不良。据报道，未经治疗的成年CD患者血清锌水平较低。在本研究中，我们将58名4岁以下因乳糜泻接受调查的儿童的血清锌浓度与小肠黏膜形态相关联。与无肠病的非乳糜泻儿童（15.1±2.3）（n = 16）、无肠病的采用无麸质饮食的乳糜泻儿童（14.2±1.6）（n = 14）、有肠病的接受麸质激发试验的乳糜泻儿童（14.1±2.1）（n = 12）以及无肠病的接受麸质激发试验的乳糜泻儿童（13.8±1.9）（n = 6）相比，未经治疗的有肠病的乳糜泻儿童（9.7±2.0）（n = 11）的血清锌平均浓度（平均值±标准差；μmol/L）显著更低（p < 0.001、p < 0.001、p < 0.001、p < 0.005）。
未经治疗的有肠病的乳糜泻儿童血清锌浓度降低，采用无麸质饮食后恢复正常。因此，临床上因可能患有CD而接受调查的儿童血清锌值低可作为肠病的补充标志物，提示需进一步进行小肠活检。文中还讨论了锌在CD发病机制中的假设作用。
