Bavykina I A, Zvyagin A A, Petrova I V, Nastausheva T L
Burdenko Voronezh State Medical University, Voronezh, Russia.
Center of Social Rehabilitation of Children with Disabilities 'Sail of hope', Voronezh, Russia.
Zh Nevrol Psikhiatr Im S S Korsakova. 2018;118(5. Vyp. 2):64-68. doi: 10.17116/jnevro20181185264.
To study serological and genetic markers of gluten intolerance in children and teenagers with autism spectrum disorders (ASD) and Down's syndrome (DS).
Thirty-three children with ASD (group 1) and 8 with DS (group 2), aged from 2.5 to 15 years, were examined. There were 27 boys and 6 girls in group1, 5 boys and 3 girls in group 2. Most of the children were on a regular diet and only 4 children with ASD kept gluten-free diet (GFD). Using ELI method antibodies to gliadin IgG (AntiGliadin IgG), antibodies to deamidated peptides of gliadin IgA (AntiDGP IgA), immunoglobulin A (IgA) were identified. Haplotypes HLA-DQ2 and DQ8 were determined using PCR.
AntiGliadin IgG were identified in 12.1% (4) patients of group 1, with the exception of patients on GFD in 13.8%, and in 50% patients of group 2. One child with ASD had selective IgA deficiency. Haplotypes predisposing to celiac disease had 41.9% of patients of group 1 and 37.5% of patients of group 2. In ASD, the distribution of genotypes was as follows: DQ2 (64.3%), DQ8 (28.6%), DQ2/DQ8 (7.1%,). In DS, all patients had haplotype DQ2. AntiDGP IgA were not identified in both groups.
The predominant form of gluten intolerance in children with ASD and DS is sensitivity to gluten, which can be identified in 40-50% of patients. Celiac disease, an autoimmune form of gluten intolerance, can be diagnosed in single cases, although predisposition to it is identified in 41.9% - 37.5% patients with ASD and DS, respectively. Before the start of GFD, laboratory tests should be made to identify forms of gluten intolerance and the use of GFD.
研究自闭症谱系障碍（ASD）和唐氏综合征（DS）儿童及青少年麸质不耐受的血清学和基因标志物。
对33名年龄在2.5至15岁的ASD儿童（第1组）和8名DS儿童（第2组）进行检查。第1组有27名男孩和6名女孩，第2组有5名男孩和3名女孩。大多数儿童采用常规饮食，只有4名ASD儿童保持无麸质饮食（GFD）。采用酶联免疫吸附法（ELI）检测抗麦醇溶蛋白IgG抗体（抗麦醇溶蛋白IgG）、抗麦醇溶蛋白去酰胺化肽IgA抗体（抗DGP IgA）和免疫球蛋白A（IgA）。采用聚合酶链反应（PCR）测定单倍型HLA - DQ2和DQ8。
第1组中12.1%（4例）患者检测到抗麦醇溶蛋白IgG，不包括采用GFD的患者，其比例为13.8%，第2组中50%的患者检测到该抗体。1名ASD儿童存在选择性IgA缺乏。易患乳糜泻的单倍型在第1组患者中占41.9%，在第2组患者中占37.5%。在ASD中，基因型分布如下：DQ2（64.3%）、DQ8（28.6%）、DQ2/DQ8（7.1%）。在DS中，所有患者均有单倍型DQ2。两组均未检测到抗DGP IgA。
ASD和DS儿童麸质不耐受的主要形式是对麸质敏感，40 - 50%的患者可检测到。乳糜泻作为麸质不耐受的一种自身免疫形式，虽分别在41.9% - 37.5%的ASD和DS患者中发现有易患倾向，但仅在个别病例中可诊断。在开始GFD之前，应进行实验室检测以确定麸质不耐受的形式并采用GFD。
