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大疱性表皮松解症患者接受无麸质饮食后肾功能改善:两例报告。

Improvement of renal function in epidermolysis bullosa patients after gluten free diet: two cases.

机构信息

Regional Coordination for Rare Diseases, Ares Puglia, Bari, Italy.

出版信息

Eur Rev Med Pharmacol Sci. 2012 Oct;16 Suppl 4:138-41.

Abstract

Epidermolysis bullosa (EB) is a rare inherited genetic disease characterized by an abnormal response of the skin and mucosa to mechanical trauma. Dystrophic EB (DEB) is very often associated with many extra cutaneous complications. Those complications involve either epithelial associated tissues or other organs. In particular, several renal complications have been described for DEB in the recessive form, such as amyloidosis, post-infection glomerulonephritis, upper and lower urinary tract obstruction and IgA-Nephropathy (IgAN). In the cases reported below we have two patients diagnosed with DEB that showed compromised renal function and proteinuria. The switch of the normal diet toward a gluten free diet resulted beneficial for both patients, since renal function was rescued and proteinuria cured. Moreover, a general health status improvement was recognised, given that nutritional condition was ameliorated and bone growing enhanced. Furthermore, in both patients the presence of autoantibodies anti-COL7 indicating an autoimmune form of the disease. Therefore, patients received low doses of betametasone useful to reduce inflammatory state and to control immune system function. In conclusion, our results prompt us to hypothesized that in these patients, due to the fragility of the intestinal mucosa, the absence in the diet of gluten may be beneficial.

摘要

大疱性表皮松解症(EB)是一种罕见的遗传性疾病,其特征是皮肤和粘膜对机械性创伤的异常反应。营养不良型 EB(DEB)通常与许多皮肤外并发症有关。这些并发症涉及上皮相关组织或其他器官。特别是,已经在隐性形式的 DEB 中描述了几种肾脏并发症,如淀粉样变性、感染后肾小球肾炎、上下尿路梗阻和 IgA 肾病(IgAN)。在下面报告的病例中,我们有两名诊断为 DEB 的患者,其肾功能和蛋白尿受损。将正常饮食改为无麸质饮食对两名患者均有益,因为肾功能得到了挽救,蛋白尿得到了治愈。此外,还发现患者的一般健康状况得到了改善,因为营养状况得到了改善,骨骼生长得到了增强。此外,在这两名患者中都存在抗 COL7 的自身抗体,表明存在自身免疫形式的疾病。因此,患者接受了小剂量的倍他米松治疗,以减轻炎症状态并控制免疫系统功能。总之,我们的结果促使我们假设,由于这些患者肠粘膜脆弱,饮食中缺乏麸质可能是有益的。

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