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[乳糜泻的组织学诊断与并发症。根据新的S2k指南更新]

[Histological diagnosis and complications of celiac disease. Update according to the new S2k guidelines].

作者信息

Aust D E, Bläker H

机构信息

Institut für Pathologie des Universitätsklinikums Carl Gustav Carus, TU Dresden, Fetscherstr. 74, 01309, Dresden, Deutschland,

出版信息

Pathologe. 2015 Mar;36(2):197-205; quiz 206-7. doi: 10.1007/s00292-015-0006-2.

Abstract

Celiac disease is a relatively common immunological systemic disease triggered by the protein gluten in genetically predisposed individuals. Classical symptoms like chronic diarrhea, steatorrhea, weight loss and growth retardation are nowadays relatively uncommon. Diagnostic workup includes serological tests for IgA antibodies against tissue transglutaminase 2 (anti-TG2-IgA) and total IgA and histology of duodenal biopsies. Histomorphological classification should be done according to the modified Marsh-Oberhuber classification. Diagnosis of celiac disease should be based on serological, clinical, and histological findings. The only treatment is a life-long gluten-free diet. Unchanged or recurrent symptoms under gluten-free diet may indicate refractory celiac disease. Enteropathy-associated T-cell lymphoma and adenocarcinomas of the small intestine are known complications of celiac disease.

摘要

乳糜泻是一种相对常见的免疫性全身性疾病,由麸质蛋白在具有遗传易感性的个体中引发。如今,慢性腹泻、脂肪泻、体重减轻和生长发育迟缓等典型症状相对不常见。诊断检查包括针对组织转谷氨酰胺酶2的IgA抗体(抗TG2-IgA)和总IgA的血清学检测以及十二指肠活检的组织学检查。组织形态学分类应根据改良的马什-奥伯胡伯分类法进行。乳糜泻的诊断应基于血清学、临床和组织学检查结果。唯一的治疗方法是终身无麸质饮食。无麸质饮食下症状未改善或复发可能提示难治性乳糜泻。小肠肠病相关T细胞淋巴瘤和小肠腺癌是乳糜泻已知的并发症。

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