非乳糜泻小麦敏感患者的自身免疫特征。

Autoimmunity Features in Patients With Non-Celiac Wheat Sensitivity.

机构信息

Department of Health Promotion Sciences, Maternal and Infant Care, Internal Medicine and Medical Specialties (PROMISE), University of Palermo, Palermo, Italy.

Department of Biomedicine, Neurosciences and Advanced Diagnostics, Institute of Clinical Biochemistry, Clinical Molecular Medicine and Laboratory Medicine, University of Palermo, Palermo, Italy.

出版信息

Am J Gastroenterol. 2021 May 1;116(5):1015-1023. doi: 10.14309/ajg.0000000000000919.

DOI:10.14309/ajg.0000000000000919

PMID:33009065

Abstract

INTRODUCTION

Nonceliac wheat sensitivity (NCWS) is characterized by intestinal and extraintestinal manifestations consequent to wheat ingestion in subjects without celiac disease and wheat allergy. Few studies investigated the relationship between NCWS and autoimmunity. The aim of this study is to evaluate the frequency of autoimmune diseases (ADs) and autoantibodies in patients with NCWS.

METHODS

Ninety-one patients (13 men and 78 women; mean age of 40.9 years) with NCWS, recruited in a single center, were included. Seventy-six healthy blood donors (HBD) and 55 patients with a diagnosis of irritable bowel syndrome (IBS) unrelated to NCWS served as controls. Autoantibodies levels were measured. Human leukocyte antigen haplotypes were determined, and duodenal histology performed in all patients carrying the DQ2/DQ8 haplotypes. Participants completed a questionnaire, and their medical records were reviewed to identify those with ADs.

RESULTS

Twenty-three patients with NCWS (25.3%) presented with ADs; autoimmune thyroiditis (16 patients, 17.6%) was the most frequent. The frequency of ADs was higher in patients with NCWS than in HBD (P = 0.002) and in patients with IBS (P = 0.05). In the NCWS group, antinuclear antibodies tested positive in 71.4% vs HBD 19.7%, and vs patients with IBS 21.8% (P < 0.0001 for both). The frequency of extractable nuclear antigen antibody (ENA) positivity was significantly higher in patients with NCWS (21.9%) than in HBD (0%) and patients with IBS (3.6%) (P = 0.0001 and P = 0.004, respectively). Among the patients with NCWS, 9.9% tested positive for antithyroglobulin, 16.5% for antithyroid peroxidase, and 14.3% for antiparietal cell antibodies; frequencies were not statistically different from controls. The presence of ADs was related to older age at NCWS diagnosis, female sex, duodenal lymphocytosis, and eosinophil infiltration.

DISCUSSION

One in 4 patients with NCWS suffered from AD, and serum antinuclear antibodies were positive in a very high percentage of cases. These data led us to consider NCWS to be associated to ADs.

摘要

简介

非麸质小麦敏感（NCWS）的特征是在没有乳糜泻和小麦过敏的患者中，由于摄入小麦而导致的肠内和肠外表现。很少有研究调查 NCWS 与自身免疫之间的关系。本研究旨在评估 NCWS 患者自身免疫性疾病（AD）和自身抗体的频率。

方法

在一个中心招募了 91 名 NCWS 患者（13 名男性和 78 名女性；平均年龄 40.9 岁）。76 名健康献血者（HBD）和 55 名与 NCWS 无关的肠易激综合征（IBS）患者作为对照组。测量了自身抗体水平。在所有携带 DQ2/DQ8 单体型的患者中进行了人类白细胞抗原单体型的测定，并进行了十二指肠组织学检查。参与者完成了一份问卷，对他们的病历进行了回顾，以确定那些患有 AD 的人。

结果

23 名 NCWS 患者（25.3%）患有 AD；最常见的是自身免疫性甲状腺炎（16 名患者，17.6%）。NCWS 患者的 AD 发生率高于 HBD（P=0.002）和 IBS 患者（P=0.05）。在 NCWS 组中，抗核抗体阳性率为 71.4%，HBD 为 19.7%，IBS 为 21.8%（均<0.0001）。NCWS 患者提取核抗原抗体（ENA）阳性率明显高于 HBD（21.9%）和 IBS（3.6%）（均 P=0.0001 和 P=0.004）。在 NCWS 患者中，9.9%的人抗甲状腺球蛋白抗体阳性，16.5%的人抗甲状腺过氧化物酶抗体阳性，14.3%的人抗壁细胞抗体阳性；这些频率与对照组无统计学差异。AD 的存在与 NCWS 诊断时年龄较大、女性、十二指肠淋巴细胞增多和嗜酸性粒细胞浸润有关。