Itoi K, Sasaki T, Sawai T, Nakamura M, Hiwatashi N, Muryoi T, Yokoyama N, Yoshinaga K
Department of Internal Medicine, Tohoku University School of Medicine, Sendai, Japan.
Am J Gastroenterol. 1989 Feb;84(2):187-91.
A 30-yr-old man presented with anasarca and visual disturbance. The serum albumin was 1.9 g/dl. Loss of albumin into the stomach and upper small intestine was demonstrated by technetium-99m (99mTc)-albumin scintigraphy. However, no anatomical lesions were found in the gastrointestinal tract. Renal function was normal, urinary protein was minimal, and hepatic function was near normal. A variety of autoantibodies, such as antinuclear antibodies, SS-A, SS-B, or Coombs' antibodies, were detected in serum in association with hypocomplementemia. Immunological studies revealed IgG, IgM, C1q, and C3 deposits in the walls of capillaries in the lamina propria of gastrointestinal mucosae. Combination therapy of prednisolone with an immunosuppressive agent improved the loss of albumin into the bowel and abnormal laboratory findings. This report indicates that the autoimmune process may contribute to the pathogenesis of certain types of protein-losing gastroenteropathy.
一名30岁男性出现全身性水肿和视力障碍。血清白蛋白为1.9 g/dl。通过锝-99m（99mTc）-白蛋白闪烁扫描显示白蛋白进入胃和上段小肠。然而，胃肠道未发现解剖学病变。肾功能正常，尿蛋白极少，肝功能接近正常。血清中检测到多种自身抗体，如抗核抗体、SS-A、SS-B或库姆斯抗体，并伴有补体减少。免疫学研究显示胃肠道黏膜固有层毛细血管壁中有IgG、IgM、C1q和C3沉积。泼尼松龙与免疫抑制剂联合治疗改善了白蛋白进入肠道的情况及异常实验室检查结果。本报告表明自身免疫过程可能在某些类型的失蛋白性胃肠病发病机制中起作用。
