Ozkan Mircan, Trandafir Laura, Bozomitu Laura, Azocai Alice, Murgu Alina, Popovici Paula, Stana B, Tunza-Enea Helga Alina, Moraru Evelina
Facultatea de Medicină, Universitatea de Medicină şi Farmacie "Gr.T. Popa" Iaşi.
Rev Med Chir Soc Med Nat Iasi. 2011 Oct-Dec;115(4):1030-4.
Celiac disease (CD) is an autoimmune systemic enteropathy triggered by gluten intake in patients with genetic susceptibility, characterized by clinic polymorphism: classic forms, mainly with digestive features, and atypical forms, liver involvement being a part of them. In present, any unknown cytolysis requires screening serologic determinations for CD.
to assess the presence of liver manifestations in children diagnosed with CD, the outcome of liver function with gluten-free diet (GFD) and also to emphasize the importance of the immunological screening for CD in patients with unknown etiology liver dysfunctions.
The trial was formed by 120 patients diagnosed with CD between January 2007 - December 2010 in 2nd and 3rd Pediatric Clinics of "Sf. Maria" Hospital Iaşi; liver function was assessed; viral hepatitis and autoimmune hepatitis markers were determined; all patients were given GFD, hepatoprotective agents and antivirals specific to each form of hepatitis; the transaminases level variation was followed in time.
12 of the CD diagnosed patients (10, 14%) had altered liver function at the onset of disease; the only abnormality was the increased transaminases level in 57, 14% of cases; HBsAg was found positive in 33, 33% (4 cases); liver biopsy in one patient evidenced steatosis. The study has shown that 4% of the patients with cryptogenetic hepatitis have a silent form of CD, the serologic screening for AGA, AEA, ATGA being essential for diagnosis.
we have to rule out CD in patients with liver disease of unknown etiology, before we consider it as "cryptogenetic"; occurrence of cytolysis in the absence of positive viral markers requires the assessment of screening tests for CD.
乳糜泻（CD）是一种自身免疫性全身性肠病，由遗传易感性患者摄入麸质引发，其临床特征具有多态性：典型形式主要表现为消化系统症状，非典型形式则包括肝脏受累。目前，任何不明原因的细胞溶解都需要进行乳糜泻的血清学筛查。
评估确诊为乳糜泻的儿童肝脏表现的存在情况、无麸质饮食（GFD）对肝功能的影响，并强调对病因不明的肝功能障碍患者进行乳糜泻免疫筛查的重要性。
该试验由2007年1月至2010年12月期间在雅西“圣母玛利亚 ”医院第二和第三儿科诊所确诊为乳糜泻的120例患者组成；评估肝功能；测定病毒性肝炎和自身免疫性肝炎标志物；所有患者均接受GFD、保肝药物及针对每种肝炎形式的抗病毒药物治疗；随访转氨酶水平的变化。
12例确诊为乳糜泻的患者（10.14%）在疾病发作时肝功能异常；唯一的异常是57例（14%）患者转氨酶水平升高；33例（33%，4例）患者HBsAg呈阳性；1例患者的肝脏活检显示有脂肪变性。研究表明，4%的隐源性肝炎患者患有隐性乳糜泻，对AGA、AEA、ATGA进行血清学筛查对诊断至关重要。
在将病因不明的肝病患者视为“隐源性”之前，我们必须排除乳糜泻；在没有阳性病毒标志物的情况下发生细胞溶解需要评估乳糜泻的筛查试验。
