Gawkrodger D J, McDonald C, O'Mahony S, Ferguson A
Department of Dermatology, Royal Infirmary, Edinburgh.
Gut. 1991 Apr;32(4):377-82. doi: 10.1136/gut.32.4.377.
Small intestinal morphology and function were assessed in 82 patients with dermatitis herpetiformis, 51 of whom were taking a normal diet and 31 a gluten free diet. Methods used were histopathological evaluation of jejunal mucosal biopsy specimens, quantitation of intraepithelial lymphocytes, cellobiose/mannitol permeability test, tissue disaccharidase values, serum antigliadin antibodies, and formal assessment of dietary gluten content by a dietician. There was no correlation between dietary gluten intake and the degree of enteropathy in the 51 patients taking a normal diet, whereas biopsy specimens were normal in 24 of the 31 patients on a gluten free diet, all previously having been abnormal. Eighteen patients on gluten containing diets had normal jejunal histology and in seven of these all tests of small intestinal morphology and function were entirely normal. Intestinal permeability was abnormal and serum antigliadin antibodies were present in most patients with enteropathy. Studies of acid secretion in seven patients showed that hypochlorhydria or achlorhydria did not lead to abnormal permeability in the absence of enteropathy. This study shows that a combination of objective tests of small intestinal architecture and function will detect abnormalities in most dermatitis herpetiformis patients, including some with histologically normal jejunal biopsy specimens. Nevertheless there is a small group in whom all conventional intestinal investigations are entirely normal.
对82例疱疹样皮炎患者的小肠形态和功能进行了评估，其中51例采用正常饮食，31例采用无麸质饮食。所采用的方法包括空肠黏膜活检标本的组织病理学评估、上皮内淋巴细胞定量、纤维二糖/甘露醇渗透性试验、组织二糖酶值、血清抗麦醇溶蛋白抗体，以及由营养师对饮食中麸质含量进行正式评估。在51例采用正常饮食的患者中，饮食中麸质摄入量与肠病程度之间无相关性，而在31例采用无麸质饮食的患者中，有24例活检标本正常，这些患者之前的活检标本均异常。18例食用含麸质饮食的患者空肠组织学正常，其中7例患者所有小肠形态和功能检查均完全正常。大多数肠病患者存在肠道渗透性异常和血清抗麦醇溶蛋白抗体。对7例患者的胃酸分泌研究表明，在无肠病的情况下，胃酸过少或无胃酸不会导致渗透性异常。本研究表明，小肠结构和功能的客观检查相结合能在大多数疱疹样皮炎患者中检测到异常，包括一些空肠活检标本组织学正常的患者。然而，有一小部分患者所有常规肠道检查均完全正常。
