Posthumus Lotte, Al-Toma Abdul
Department of Gastroenterology and Hepatology, St Antonius Hospital, Nieuwegein, The Netherlands.
Eur J Gastroenterol Hepatol. 2017 Aug;29(8):897-903. doi: 10.1097/MEG.0000000000000880.
Coeliac disease (CD) is a chronic immune-mediated small intestine enteropathy precipitated by gluten in genetically predisposed individuals. Adult presentation is often atypical and malabsorption of vitamins and minerals is common, with a consequent disturbance of bone metabolism. We aim to evaluate laboratory deficiencies related to bone metabolism and the relationship between severity of histological damage and degree of bone mass loss at diagnosis of CD.
A retrospective cross-sectional study of 176 adult coeliac patients was carried out. All patients fulfilled the histopathological criteria for CD. Biochemical data were analysed (calcium/phosphate/alkaline-phosphatase/vitamin D/parathormone). Duodenal histology was classified according to the Marsh classification. Bone mass density (BMD) at the lumbar and femoral regions measured by dual X-ray absorptiometry. A P-value of less than 0.05 was considered significant.
No correlation was found between the presence of gastrointestinal symptoms and the Marsh histopathological stage (P>0.05). Vitamin D deficiency was most common (44.5%), whereas only 5.7% had hypocalcaemia. Calcium was lower (P<0.05) and parathormone was higher (P=0.01) in patients with Marsh III. These patients had lower lumbar T-score (P<0.05). Although low BMD occurred in all age groups, most osteoporotic patients were aged 45-49 years (81.8%). A multiple regression analysis showed that the Marsh histopathological stage could be a predictor of lower lumbar BMD (r=0.322, B=-1.146, P<0.05).
Laboratory deficiencies and decreased BMD could be severe and unrelated to the presence of gastrointestinal symptoms. At diagnosis, the Marsh histopathological stage could predict the occurrence of low BMD, which carries a risk of developing into osteoporosis. In coeliac patients older than 30 years, evaluation of bone biomarkers and dual X-ray absorptiometry examination should be considered.
乳糜泻（CD）是一种由麸质引发的慢性免疫介导性小肠肠病，好发于具有遗传易感性的个体。成人乳糜泻的临床表现通常不典型，维生素和矿物质吸收不良较为常见，进而导致骨代谢紊乱。我们旨在评估与骨代谢相关的实验室指标缺乏情况，以及乳糜泻诊断时组织学损伤严重程度与骨质流失程度之间的关系。
对176例成年乳糜泻患者进行了一项回顾性横断面研究。所有患者均符合乳糜泻的组织病理学标准。分析生化数据（钙/磷/碱性磷酸酶/维生素D/甲状旁腺激素）。十二指肠组织学根据马什分类法进行分类。通过双能X线吸收法测量腰椎和股骨区域的骨密度（BMD）。P值小于0.05被认为具有统计学意义。
未发现胃肠道症状的存在与马什组织病理学分期之间存在相关性（P>0.05）。维生素D缺乏最为常见（44.5%），而仅有5.7%的患者存在低钙血症。马什III期患者的钙水平较低（P<0.05），甲状旁腺激素水平较高（P=0.01）。这些患者的腰椎T值较低（P<0.05）。尽管所有年龄组均出现低骨密度，但大多数骨质疏松患者年龄在45 - 49岁之间（81.8%）。多元回归分析表明，马什组织病理学分期可能是腰椎骨密度降低的一个预测指标（r = 0.322，B = -1.146，P<0.05）。
实验室指标缺乏和骨密度降低可能较为严重，且与胃肠道症状的存在无关。在诊断时，马什组织病理学分期可预测低骨密度的发生，而低骨密度有发展为骨质疏松的风险。对于年龄大于30岁的乳糜泻患者，应考虑评估骨生物标志物和进行双能X线吸收法检查。
