肝病患者中的乳糜泻标志物：一项单中心大规模筛查研究。
Celiac disease markers in patients with liver diseases: a single center large scale screening study.
机构信息
Department of Hepatogastroenterology, Institute for Clinical and Experimental Medicine, 14021 Prague, Czech Republic.
出版信息
World J Gastroenterol. 2012 Nov 21;18(43):6255-62. doi: 10.3748/wjg.v18.i43.6255.
AIM
To study the coincidence of celiac disease, we tested its serological markers in patients with various liver diseases.
METHODS
Large-scale screening of serum antibodies against tissue transglutaminase (tTG), and deamidated gliadin using enzyme-linked immunosorbent assay and serum antibodies against endomysium using immunohistochemistry, in patients with various liver diseases (n = 962) and patients who underwent liver transplantation (OLTx, n = 523) was performed. The expression of tTG in liver tissue samples of patients simultaneously suffering from celiac disease and from various liver diseases using immunohistochemistry was carried out. The final diagnosis of celiac disease was confirmed by histological analysis of small-intestinal biopsy.
RESULTS
We found that 29 of 962 patients (3%) with liver diseases and 5 of 523 patients (0.8%) who underwent OLTx were seropositive for IgA and IgG anti-tTG antibodies. However, celiac disease was biopsy-diagnosed in 16 patients: 4 with autoimmune hepatitis type I, 3 with Wilson's disease, 3 with celiac hepatitis, 2 with primary sclerosing cholangitis, 1 with primary biliary cirrhosis, 1 with Budd-Chiari syndrome, 1 with toxic hepatitis, and 1 with non-alcoholic steatohepatitis. Unexpectedly, the highest prevalence of celiac disease was found in patients with Wilson's disease (9.7%), with which it is only rarely associated. On the other hand, no OLTx patients were diagnosed with celiac disease in our study. A pilot study of the expression of tTG in liver tissue using immunohistochemistry documented the overexpression of this molecule in endothelial cells and periportal hepatocytes of patients simultaneously suffering from celiac disease and toxic hepatitis, primary sclerosing cholangitis or autoimmune hepatitis type I.
CONCLUSION
We suggest that screening for celiac disease may be beneficial not only in patients with associated liver diseases, but also in patients with Wilson's disease.
目的
为了研究乳糜泻的一致性，我们在各种肝病患者中检测了其血清学标志物。
方法
对 962 例各种肝病患者和 523 例肝移植患者（OLTx）进行了血清组织转谷氨酰胺酶（tTG）和脱酰胺麦胶蛋白的酶联免疫吸附试验及血清内肌内膜抗体的大规模筛查，同时用免疫组织化学法检测了同时患有乳糜泻和各种肝病患者的肝组织标本中 tTG 的表达。通过对小肠活检的组织学分析来确认乳糜泻的最终诊断。
结果
我们发现，962 例肝病患者中有 29 例（3%）和 523 例 OLTx 患者中有 5 例（0.8%）血清 IgA 和 IgG 抗 tTG 抗体阳性，但活检诊断为乳糜泻的患者有 16 例：1 例自身免疫性肝炎 I 型，3 例 Wilson 病，3 例乳糜泻性肝炎，2 例原发性硬化性胆管炎，1 例原发性胆汁性肝硬化，1 例 Budd-Chiari 综合征，1 例中毒性肝炎，1 例非酒精性脂肪性肝炎。出乎意料的是，Wilson 病患者的乳糜泻患病率最高（9.7%），这与Wilson 病很少相关。另一方面，我们的研究中没有 OLTx 患者被诊断为乳糜泻。一项使用免疫组织化学法检测 tTG 在肝组织中表达的初步研究表明，患有乳糜泻和中毒性肝炎、原发性硬化性胆管炎或自身免疫性肝炎 I 型的患者的内皮细胞和门周肝细胞中该分子表达过度。
结论
我们建议，不仅在伴有肝病的患者中，而且在伴有 Wilson 病的患者中筛查乳糜泻可能是有益的。
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