Pediatric Research Center and Medical School, University of Tampere, FIN-33014 Tampere, Finland.
Dig Liver Dis. 2010 Oct;42(10):692-7. doi: 10.1016/j.dld.2010.03.008. Epub 2010 Apr 20.
The diagnosis of coeliac disease is problematic in individuals not responding to a gluten-free diet. Small-bowel villous atrophy occurs in other enteropathies and non-responsive patients are often seronegative. We investigated whether small-bowel mucosal transglutaminase-2 specific autoantibody deposits distinguish non-responsive coeliac disease from other enteropathies.
Small-bowel mucosal autoantibody deposits were determined in 27 non-responsive, 28 responsive coeliac patients and 10 controls with other enteropathies. Of the non-responsive coeliac patients six were adhering poorly and 21 strictly to the diet; six of the 21 had enteropathy-associated lymphoma, five refractory coeliac disease and 10 otherwise persistent villous atrophy. The presence of mucosal autoantibody deposits was compared to serology, villous morphology, densities of intraepithelial lymphocytes (IELs) and markers of refractory coeliac disease.
Twenty out of 21 well-adhering, all six poorly adhering non-responsive and all 28 untreated responsive coeliac patients had small-bowel mucosal autoantibody deposits present, while controls with other enteropathies were negative. Small-bowel mucosal autoantibody deposits were more accurate in detecting coeliac disease than serology or IEL densities. Refractory coeliac markers revealed only cases with the most severe condition.
Small-bowel mucosal autoantibody deposits differentiate coeliac disease from other enteropathies, enabling the design of appropriate therapeutic strategies.
在对无麸质饮食无反应的个体中，乳糜泻的诊断存在问题。小肠道绒毛萎缩发生在其他肠病和无反应患者中，且这些患者通常为血清阴性。我们研究了小肠黏膜转谷氨酰胺酶 2 特异性自身抗体沉积是否可以区分无反应性乳糜泻与其他肠病。
在 27 例无反应性、28 例反应性乳糜泻患者和 10 例其他肠病的对照者中，确定了小肠黏膜自身抗体沉积。在 21 例严格遵循饮食的无反应性乳糜泻患者中，6 例饮食依从性差，21 例患者中有 6 例存在肠病相关淋巴瘤，5 例难治性乳糜泻和 10 例其他持续的绒毛萎缩。将黏膜自身抗体沉积的存在与血清学、绒毛形态、上皮内淋巴细胞 (IEL) 密度和难治性乳糜泻标志物进行比较。
21 例依从性好的患者、6 例依从性差的无反应性患者和 28 例未经治疗的反应性乳糜泻患者均存在小肠黏膜自身抗体沉积，而其他肠病的对照者均为阴性。与血清学或 IEL 密度相比，小肠黏膜自身抗体沉积更能准确地检测出乳糜泻。难治性乳糜泻标志物仅揭示了最严重的病例。
小肠黏膜自身抗体沉积可将乳糜泻与其他肠病区分开来，从而能够制定适当的治疗策略。
