无麸质饮食对新诊断的乳糜泻患儿蛋白尿的影响。
Effect of a gluten-free diet on albuminuria in children with newly diagnosed celiac disease.
作者信息
Levine Jeremiah, Hauptman Leora, Moy Libia, Trachtman Howard
机构信息
NYU Langone Health, Department of Pediatrics, Divisions of Gastroenterology, New York, NY.
NYU Langone Health, Department of Pediatrics, Divisions Nephrology, New York, NY.
出版信息
Glomerular Dis. 2021 Apr;1(1):3-9. doi: 10.1159/000514635. Epub 2021 Mar 18.
BACKGROUND AND OBJECTIVES
Altered gastrointestinal permeability in celiac disease (CD) is mediated by zonulin. The receptor for zonulin is expressed on podocytes. Therefore, we tested the effect of a gluten-free diet (GFD) on albuminuria in pediatric patients with newly diagnosed CD.
METHODS
We performed a cohort study comparing urinary albumin (μg):creatinine (mg) ratio (ACR) in CD patients vs controls and in response to a GFD.
RESULTS
Children with CD (n=46) had higher ACR compared to controls (n=21), 20.2±5.6 versus 8.4±1.1 μg/mg, P=0.16 and exceeded 30 μg/mg (microalbuminuria cut-off) in 7/46 cases. 17 patients had a follow-up assessment (interval 6.1±0.7 months) on a GFD. Baseline ACR was 20.7±5.2 that fell to 10.4±1.5 μg/mg, P=0.035.
CONCLUSION
Children and adolescents with newly diagnosed CD have low-grade albuminuria that is numerically higher than controls and that declined after implementation of a GFD. CD may be associated with reversible defects in the glomerular barrier.
背景与目的
乳糜泻（CD）中胃肠道通透性的改变由zonulin介导。zonulin的受体在足细胞上表达。因此，我们测试了无麸质饮食（GFD）对新诊断的小儿CD患者蛋白尿的影响。
方法
我们进行了一项队列研究，比较了CD患者与对照组以及对GFD反应时的尿白蛋白（μg）：肌酐（mg）比值（ACR）。
结果
与对照组（n = 21）相比，CD患儿（n = 46）的ACR更高，分别为20.2±5.6和8.4±1.1μg/mg，P = 0.16，且46例中有7例超过30μg/mg（微量白蛋白尿临界值）。17例患者在GFD饮食下进行了随访评估（间隔6.1±0.7个月）。基线ACR为20.7±5.2，降至10.4±1.5μg/mg，P = 0.035。
结论
新诊断的CD儿童和青少年存在轻度蛋白尿，其数值高于对照组，且在实施GFD后下降。CD可能与肾小球屏障的可逆性缺陷有关。
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