Loft D E, Marsh M N, Crowe P T
University Department of Medicine, Hope Hospital (University of Manchester School of Medicine), Salford, UK.
Lancet. 1990 Jun 2;335(8701):1293-5. doi: 10.1016/0140-6736(90)91183-b.
44 patients referred consecutively for jejunal biopsy underwent rectal gluten challenge with 2 g peptic-tryptic digest (Frazer's fraction III; FF3). Rectal biopsy was done before the challenge and 6 h afterwards. Total intraepithelial lymphocytes (IEL) overlying a 10(4) micron 2 test area of muscularis mucosae were quantified by computerised image analysis. The subjects comprised 21 controls with disorders other than coeliac disease and 23 patients (14 treated, 9 untreated) with coeliac disease diagnosed by strict jejunal biopsy gold standard criteria. There was no difference between the groups in IEL numbers before challenge. Coeliac disease patients but not controls responded to FF3 with a rise in mucosal IEL (median 60.5% rise for treated, 63.0% for untreated). There was no response to challenge with beta-lactoglobulin in coeliac disease or control subjects. When a predefined, post-challenge IEL "predictive index" of more than 10% above baseline was used to indicate a diagnosis of coeliac disease, it gave a sensitivity of 90% and specificity of 91% (95% confidence intervals 78-93%). Rectal gluten challenge is a simple, safe, and reliable test of gluten sensitivity, both as a screening test for untreated coeliac disease and as a confirmatory test in patients with treated coeliac disease.
44例连续接受空肠活检的患者接受了直肠麸质激发试验，使用2g胃蛋白酶-胰蛋白酶消化物（弗雷泽III级分馏物；FF3）。在激发试验前及试验后6小时进行直肠活检。通过计算机图像分析对覆盖10(4)平方微米黏膜肌层测试区域的上皮内淋巴细胞（IEL）总数进行定量。研究对象包括21名患有除乳糜泻以外其他疾病的对照者以及23例（14例接受治疗，9例未接受治疗）经严格空肠活检金标准确诊为乳糜泻的患者。激发试验前两组的IEL数量无差异。乳糜泻患者而非对照者对FF3有反应，黏膜IEL数量增加（接受治疗者中位数增加60.5%，未接受治疗者增加63.0%）。乳糜泻患者或对照者对β-乳球蛋白激发试验均无反应。当使用预先定义的、激发试验后IEL“预测指数”高于基线10%以上来诊断乳糜泻时，其敏感性为90%，特异性为91%（95%置信区间78 - 93%）。直肠麸质激发试验是一种简单、安全且可靠的麸质敏感性检测方法，既可用作未治疗乳糜泻的筛查试验，也可用作已治疗乳糜泻患者的确诊试验。
