Caio Giacomo, De Giorgio Roberto, Venturi Alessandro, Giancola Fiorella, Latorre Rocco, Boschetti Elisa, Serra Mauro, Ruggeri Eugenio, Volta Umberto
Department of Medical and Surgical Sciences, University of Bologna and St. Orsola-Malpighi Hospital, Bologna, Italy.
Gastroenterol Hepatol Bed Bench. 2015 Spring;8(2):146-52.
To assess anti-neuronal antibodies (NA) prevalence and their correlation with neurological disorders and bowel habits in celiac disease (CD) patients.
Neurological manifestations are estimated to occur in about 10% of celiac disease patients and NA to central nervous system (CNS) and enteric nervous system (ENS) are found in a significant proportion of them. Little is known about the clinical and immunological features in CD patients with neurological manifestations.
NA to CNS and ENS were investigated in 106 CD patients and in 60 controls with autoimmune disorders by indirect immunofluorescence on rat / primate cerebellar cortex and intestinal (small and large bowel) sections.
IgG NA to CNS (titer 1:50 - 1:400) were positive in 23 celiacs (21%), being more frequently detected in those with neurological disorders that in those without neurological dysfunction (49% vs. 8%, P< 0.0001). Of the 26 celiacs (24%) with IgG NA to ENS, 11 out of 12 with an antibody titer > 1:200 had severe constipation. Only one patient with cerebellar ataxia and intestinal sub-occlusion was positive for NA to CNS and ENS. NA to CNS and ENS were found in 7% and 5% of controls, respectively.
In CD the positivity of NA to CNS can be regarded as a marker of neurological manifestations. High titer NA to ENS are associated with severe constipation. The demonstration of NA to CNS and ENS suggests an immune-mediated pathogenesis leading to central neural impairment as well as gut dysfunction (hence constipation), respectively.
评估腹腔疾病（CD）患者中抗神经元抗体（NA）的患病率及其与神经系统疾病和肠道习惯的相关性。
据估计，约10%的腹腔疾病患者会出现神经学表现，并且其中很大一部分患者体内存在针对中枢神经系统（CNS）和肠神经系统（ENS）的NA。对于有神经学表现的CD患者的临床和免疫学特征知之甚少。
通过对大鼠/灵长类动物小脑皮质和肠道（小肠和大肠）切片进行间接免疫荧光检测，对106例CD患者和60例自身免疫性疾病对照者的CNS和ENS的NA进行研究。
23例腹腔疾病患者（21%）的IgG NA对CNS呈阳性（滴度为1:50 - 1:400），在有神经疾病的患者中比没有神经功能障碍的患者更频繁地检测到（49%对8%，P<0.0001）。在26例对ENS呈IgG NA阳性的腹腔疾病患者（24%）中，12例抗体滴度>1:200的患者中有11例患有严重便秘。只有1例小脑共济失调和肠道不完全梗阻患者的CNS和ENS的NA呈阳性。对照组中CNS和ENS的NA阳性率分别为7%和5%。
在CD中，NA对CNS的阳性可被视为神经学表现的标志物。高滴度的NA对ENS与严重便秘相关。NA对CNS和ENS的证实表明分别存在导致中枢神经损伤以及肠道功能障碍（因此便秘）的免疫介导发病机制。
