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乳糜泻的药物治疗——“从实验台到病床边”

[Drug therapy in coeliac disease - "from bench to bedside"].

作者信息

Stein Jürgen, Schulzke Jörg-Dieter, Schuppan Detlef

机构信息

Gastroenterologie/Ernährungsmedizin, DGD Kliniken Sachsenhausen, Frankfurt am Main, Deutschland.

Interdisziplinäres Crohn-Colitis-Centrum Rhein-Main, Frankfurt am Main, Deutschland.

出版信息

Z Gastroenterol. 2018 Feb;56(2):151-164. doi: 10.1055/s-0043-121345. Epub 2017 Nov 7.

Abstract

Coeliac disease is one of the most common diseases worldwide, with an estimated global prevalence of 0.5 - 1 %. The disease is triggered by a combination of environmental (gluten proteins from wheat, rye or barley) and genetic factors (mainly the human leucocyte antigens HLA-DQ2 or -DQ8). At present, a strict gluten-free diet (GFD) represents the only treatment option. However, strict adherence to a GFD is challenging, since even highly motivated patients may be subject to inadvertent or background exposure to gluten. Thus, rigorous avoidance of gluten necessitates extensive constraint of patients' food choices and social interactions. Moreover, even in fully adherent patients, a GFD may fail to induce clinical or histological normalisation. New (adjunctive) non-dietary therapeutic strategies for patients with coeliac disease are therefore of great interest. In this review, on the basis of the current understanding of its pathophysiology, we examine and discuss novel pharmacological approaches for the treatment of coeliac disease.

摘要

乳糜泻是全球最常见的疾病之一,全球估计患病率为0.5%-1%。该疾病由环境因素(来自小麦、黑麦或大麦的麸质蛋白)和遗传因素(主要是人类白细胞抗原HLA-DQ2或-DQ8)共同引发。目前,严格的无麸质饮食(GFD)是唯一的治疗选择。然而,严格坚持GFD具有挑战性,因为即使积极性很高的患者也可能无意中或在日常中接触到麸质。因此,严格避免麸质需要极大地限制患者的食物选择和社交互动。此外,即使是完全坚持的患者,GFD也可能无法使临床或组织学恢复正常。因此,针对乳糜泻患者的新的(辅助性)非饮食治疗策略备受关注。在本综述中,基于对其病理生理学的当前理解,我们研究并讨论治疗乳糜泻的新型药理学方法。

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