Centre for Rehabilitation Research, Örebro University Hospital, Örebro, Sweden.
J Pediatr Gastroenterol Nutr. 2013 Feb;56(2):233-8. doi: 10.1097/MPG.0b013e318272cbf4.
Undernourishment is common in children with cerebral palsy (CP), but the reasons are unknown. We previously reported elevated levels of immunoglobulin (Ig) A and IgG antibodies against gliadin (AGA) and tissue transglutaminase (tTG) in 99 children and young adults with CP without characteristic findings of gluten enteropathy in small bowel biopsies. Our aim was to perform a case-control study of IgG antibodies against other dietary antigens, AGA, anti-tTG, and IgE antibodies against wheat and gluten.
Sera from 99 cases with CP and 99 healthy, age- and sex-matched controls were analysed with fluorescence enzyme-linked immunosorbent assay for detection of IgG antibodies against β-lactoglobulin, casein, egg white, IgG- and IgA-AGA, IgA-anti-tTG, and IgE antibodies against gluten and wheat.
Compared with controls, the odds ratio in cases with CP for having elevated levels of IgG antibodies against β-lactoglobulin was 17.0 (95% confidence interval [CI] 2.3-128), against casein 11.0 (95% CI 2.6-46.8), and against egg white 7.0 (95% CI 1.6-30.8). The IgE responses for wheat/gluten were generally low. The tetraplegic and dyskinetic CP subtypes had significantly higher frequencies of elevated levels for all of the tested antibodies except IgG against egg white, and IgA-anti-tTG. A significantly lower weight was seen in cases with CP with positive versus negative serology.
Elevated levels of IgG against dietary antigens were more frequent in the CP group compared with controls, and particularly in the tetraplegic and dyskinetic CP subtypes with the most severe neurologic handicap and undernourishment. Hypothetically, malnourishment may cause increased intestinal permeability and thus immunization against dietary antigens.
脑性瘫痪（CP）患儿普遍存在营养不良，但原因不明。我们之前报道过，99 例 CP 患儿和年轻患者的血清中，针对麦胶蛋白（AGA）和组织转谷氨酰胺酶（tTG）的免疫球蛋白（Ig）A 和 IgG 抗体水平升高，但小肠活检未发现典型的麸质肠病。我们的目的是对针对其他膳食抗原的 IgG 抗体、AGA、抗 tTG 以及针对小麦和谷蛋白的 IgE 抗体进行 CP 病例对照研究。
采用荧光酶联免疫吸附试验检测 99 例 CP 患儿和 99 例年龄和性别匹配的健康对照者血清中针对β-乳球蛋白、酪蛋白、卵清蛋白、IgG 和 IgA-AGA、IgA-抗 tTG 以及针对谷蛋白和小麦的 IgE 抗体。
与对照组相比，CP 患儿 IgG 抗β-乳球蛋白抗体升高的比值比（OR）为 17.0（95%可信区间 [CI] 2.3-128），抗酪蛋白抗体升高的 OR 为 11.0（95% CI 2.6-46.8），抗卵清蛋白抗体升高的 OR 为 7.0（95% CI 1.6-30.8）。针对小麦/谷蛋白的 IgE 反应通常较低。痉挛性四肢瘫和不随意运动型 CP 亚型的所有检测抗体阳性率均显著高于对照组，除 IgG 抗卵清蛋白抗体和 IgA-抗 tTG 抗体外。与血清学阴性患者相比，CP 患者的体重明显较低。
与对照组相比，CP 组患者针对膳食抗原的 IgG 抗体水平升高更为常见，尤其是在痉挛性四肢瘫和不随意运动型 CP 亚型中，这些患者的神经功能障碍最严重且存在营养不良。推测营养不良可能导致肠道通透性增加，从而针对膳食抗原发生免疫。
