Paediatric Gastroenterology, Hepatology and Nutrition Unit, Department of Paediatrics, University Clinical Hospital of Santiago de Compostela, Travesa da Choupana, s/n CP 15706, Santiago de Compostela, A Coruña, Spain.
Immunological Laboratory, University Clinical Hospital of Santiago de Compostela, Santiago de Compostela, Spain.
J Physiol Biochem. 2018 Feb;74(1):153-158. doi: 10.1007/s13105-017-0586-9. Epub 2017 Aug 16.
According to new ESPGHAN guidelines, gluten challenge is considered necessary when there is doubt about the initial diagnosis of celiac disease (CD). The main aim of this study was to quantify intraepithelial lymphocyte (IEL) immunophenotype on celiac patients on gluten-containing diet (GCD) compared to those on gluten-free diet (GFD). Another aim was to evaluate the clinical utility of IELs in the CD diagnosis, especially in selected patients on GFD where diagnostic uncertainty remains. IEL immunophenotype (TCRγδ and NK-like IELs) were studied by flow cytometry in 111 children with CD (81 children with CD on GCD and 30 celiac patients on GFD) and a control group (10 children). Duration of GFD was 5.4 ± 1.6 years. TCRγδ IELs in celiac patients receiving a GCD or GFD were significantly higher (p < 0.001) than in the control group. NK-like IELs in patients receiving a GCD or GFD were significantly lower than in the control group (p < 0.001). We observed a permanent decrease of NK-like IELs and an increment of TCRγδ IELs after following an adequate establishment and compliance of a long-term GFD in celiac patients. Recognition of IELs changes in the intestinal mucosa on celiac patients after long-term establishment of a GFD could constitute a useful tool for CD diagnosis in various situations: in which there is doubt about the initial diagnosis and repeat biopsy is necessary (avoiding the need of gluten challenges), and in those patients with symptoms/signs suggestive of CD who maintain a low gluten diet.
根据新的 ESPGHAN 指南，当对乳糜泻（CD）的初始诊断存在疑问时，应考虑进行 gluten challenge。本研究的主要目的是定量分析在 gluten-containing diet（GCD）和 gluten-free diet（GFD）下乳糜泻患者的上皮内淋巴细胞（IEL）免疫表型。另一个目的是评估 IEL 在 CD 诊断中的临床应用价值，尤其是在那些仍存在诊断不确定性的接受 GFD 的患者中。通过流式细胞术研究了 111 例 CD 患儿（81 例 CD 患儿接受 GCD，30 例 CD 患儿接受 GFD）和对照组（10 例儿童）的 IEL 免疫表型（TCRγδ 和 NK-like IELs）。GFD 的持续时间为 5.4±1.6 年。接受 GCD 或 GFD 的乳糜泻患者的 TCRγδ IEL 明显高于对照组（p<0.001）。接受 GCD 或 GFD 的患者的 NK-like IEL 明显低于对照组（p<0.001）。在乳糜泻患者长期接受 GFD 后，我们观察到 NK-like IEL 的永久性减少和 TCRγδ IEL 的增加。长期接受 GFD 后，乳糜泻患者肠道黏膜中 IEL 的变化可能成为 CD 诊断的有用工具：在对初始诊断有疑问且需要重复活检（避免 gluten challenge 的需要）的情况下，以及在有 CD 症状/体征且仍保持低麸质饮食的患者中。
