Ist Medical Department, Division of Gastroenterology and Hepatology, Charles University Medical Faculty and Teaching Hospital, Alej Svobody 80, 30460, Pilsen, Czech Republic,
Wien Klin Wochenschr. 2013 Nov;125(21-22):696-703. doi: 10.1007/s00508-013-0437-9. Epub 2013 Oct 23.
The aim of this study was to identify pitfalls in establishing the diagnosis of celiac disease (CD) in patients with a history of lymphoma.
A total of 103 patients with a history of lymphoma had anti-tissue transglutaminase antibodies (atTGA) and their class A, G, and M immunoglobulin (IgA, IgG) levels determined. Patients with atTGA positivity underwent enterobiopsy and CD-associated HLA locus testing.
The mean age of patients was 55 ( ± 13.5) years. The predominant lymphoma types included B-type non-Hodgkin's lymphoma (B-NHL, 66 %), T-type NHL (8 %), and Hodgkin's lymphoma (26 %). Serological positivity was documented in 3.9 % of cases; one patient had the diagnosis of CD confirmed by enterobiopsy. In 11 patients (10.7 %), IgA levels were decreased to a various extent; of these patients, 10 were shown to have also their IgG levels decreased. The median time from follow-up to blood collection was 58 (32-104) months. The decrease in immunoglobulin levels correlated with a more advanced stage of the tumor (Ann Arbor III-IV) at the time of diagnosis [1.4 (0.9-2.0) g/l versus 2.4 (1.5-3.0) g/l for IgA, p = 0.0001; and 9.4 (7.2-11.5) g/l versus 11.2 (10.3-12.3) g/l for IgG, p = 0.001] and older age [65 (54-72) years versus 55 (44-61) years for IgA, p = 0.04; and 69 (59-74) years versus 53 (43-61) years for IgG, p = 0.0001]. Rituximab therapy in B-NHL patients had no effect on the subsequent incidence of decreased IgA levels.
Reduced IgA and IgG levels represent important factors contributing to the low detection rate of serological screening for CD in patients with a history of lymphoma.
本研究旨在确定有淋巴瘤病史的患者在诊断乳糜泻（CD）时可能出现的陷阱。
共纳入 103 例有淋巴瘤病史的患者，检测其抗组织转谷氨酰胺酶抗体（atTGA）及免疫球蛋白 A（IgA）、免疫球蛋白 G（IgG）的 A、G、M 类水平。atTGA 阳性患者行肠活检及 CD 相关 HLA 基因座检测。
患者的平均年龄为 55（±13.5）岁。主要的淋巴瘤类型包括 B 型非霍奇金淋巴瘤（B-NHL，66%）、T 型 NHL（8%）和霍奇金淋巴瘤（26%）。3.9%的病例血清学阳性；1 例患者经肠活检确诊为 CD。11 例（10.7%）患者的 IgA 水平不同程度降低，其中 10 例同时伴有 IgG 水平降低。从随访到采血的中位时间为 58（32-104）个月。免疫球蛋白水平降低与诊断时肿瘤分期较晚（Ann Arbor III-IV 期）相关[1.4（0.9-2.0）g/L 比 IgA 2.4（1.5-3.0）g/L，p=0.0001；9.4（7.2-11.5）g/L 比 IgG 11.2（10.3-12.3）g/L，p=0.001]和年龄较大[65（54-72）岁比 IgA 55（44-61）岁，p=0.04；69（59-74）岁比 IgG 53（43-61）岁，p=0.0001]。B-NHL 患者接受利妥昔单抗治疗对随后 IgA 水平降低的发生率无影响。
IgA 和 IgG 水平降低是导致有淋巴瘤病史的患者 CD 血清学筛查检出率较低的重要因素。
