O'Mahony S, Vestey J P, Ferguson A
Gastrointestinal Unit, University of Edinburgh, Western General Hospital, UK.
Lancet. 1990 Jun 23;335(8704):1487-90. doi: 10.1016/0140-6736(90)93029-o.
Intestinal humoral immunity was examined in eight patients with dermatitis herpetiformis and normal jejunal histology (as determined by quantitative morphometry) on a gluten-containing diet. Jejunal aspirate was taken at the time of jejunal biopsy, and levels of total immunoglobulins (IgA, IgM, IgG) and specific antibody to gliadin and two other dietary proteins, betalactoglobulin and ovalbumin, were measured. The pattern of secretory immune responses in the dermatitis herpetiformis patients was similar to that in twenty-six patients with untreated coeliac disease--ie, higher than normal concentrations of IgA, IgM, and IgG and high levels of specific antibodies (IgA and IgM) to the three dietary proteins. Serum levels of IgA antigliadin were similar in the dermatitis herpetiformis and control (twenty-eight patients who underwent jejunal biopsy to exclude coeliac disease) groups, and serum levels of IgG antigliadin were intermediate between those of the control and coeliac disease groups. These findings suggest that investigation of gut humoral immunity may provide a diagnostic index of latent coeliac disease. The definition of coeliac disease as a permanent gluten-sensitive enteropathy may have to be revised if the proposed two-stage model is confirmed.
对八名患有疱疹样皮炎且空肠组织学正常（通过定量形态学确定）并食用含麸质饮食的患者进行了肠道体液免疫检查。在空肠活检时采集空肠抽吸物，测量总免疫球蛋白（IgA、IgM、IgG）水平以及针对麦醇溶蛋白和其他两种膳食蛋白（β-乳球蛋白和卵清蛋白）的特异性抗体水平。疱疹样皮炎患者的分泌免疫反应模式与26名未经治疗的乳糜泻患者相似，即IgA、IgM和IgG浓度高于正常水平，且针对这三种膳食蛋白的特异性抗体（IgA和IgM）水平较高。疱疹样皮炎组和对照组（28名接受空肠活检以排除乳糜泻的患者）的血清抗麦醇溶蛋白IgA水平相似，血清抗麦醇溶蛋白IgG水平介于对照组和乳糜泻组之间。这些发现表明，对肠道体液免疫的研究可能为潜在乳糜泻提供诊断指标。如果所提出的两阶段模型得到证实，乳糜泻作为一种永久性麸质敏感肠病的定义可能需要修订。
