Bai J C, Sambuelli A, Sugai E, Pedreira S, Kogan Z, Boerr L A, Martinez C, Maurino E C
Small Bowel Section, Hospital Nacional de Gastroenterologia, Dr. Carlos B. Udaondo, Buenos Aires, Argentina.
Am J Gastroenterol. 1991 Mar;86(3):312-6.
Our aim in this study was to monitor changes of the intestinal structure by alpha 1-antitrypsin clearance (alpha 1-ATCL) in order to offer an alternative to the gluten challenge biopsy. In addition, we evaluated the possibility of reducing the time of gluten challenge. Twelve patients had a presumptive diagnosis of celiac disease based on clinical and histological grounds. They were studied when the jejunal histology was normal after gluten-free diet and an alpha 1-ATCL was normal. The gluten was introduced by returning to a normal diet. The challenge lasted 4 wk. We measured alpha 1-ATCL at the end of the 1st and 4th wk, and a new jejunal biopsy was obtained at the end of the 4th wk. By wk 1, alpha 1-ATCL was abnormal in 11 patients but normal in one. By wk 4, alpha 1-ATCL was abnormal in 10 patients and still normal in one. The post-challenge biopsies showed atrophy in 11 and was normal only in the patient with normal alpha 1-ATCL at wk 1 and 4. One patient with abnormal alpha 1-ATCL had to stop the challenge at the first week. The patient with normal clearance at wk 1 and 4 and normal biopsy at wk 4 had abnormal results at 6 months. These data support our hypothesis that alpha 1-ATCL can be used as evidence of gluten toxicity after gluten challenge, and that this test can be abnormal as early as 1 wk after gluten is reintroduced.
本研究的目的是通过α1 -抗胰蛋白酶清除率（alpha 1 - ATCL）监测肠道结构的变化，以便为麸质激发活检提供一种替代方法。此外，我们评估了缩短麸质激发时间的可能性。12例患者基于临床和组织学依据被初步诊断为乳糜泻。在无麸质饮食后空肠组织学正常且alpha 1 - ATCL正常时对他们进行研究。通过恢复正常饮食引入麸质。激发持续4周。我们在第1周和第4周结束时测量alpha 1 - ATCL，并在第4周结束时获取新的空肠活检样本。到第1周时，11例患者的alpha 1 - ATCL异常，1例正常。到第4周时，10例患者的alpha 1 - ATCL异常，1例仍正常。激发后活检显示11例有萎缩，仅在第1周和第4周alpha 1 - ATCL正常的患者中活检结果正常。1例alpha 1 - ATCL异常的患者在第一周不得不停止激发。在第1周和第4周清除率正常且在第4周活检正常的患者在6个月时结果异常。这些数据支持我们的假设，即alpha 1 - ATCL可作为麸质激发后麸质毒性的证据，并且该测试在重新引入麸质后1周就可能异常。
