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一名肥胖患者的严重肝损伤：乳糜泻发病还是重叠综合征？

Severe Liver Damage in an Obese Patient: Onset of Celiac Disease or Overlap Syndrome?

作者信息

Ghiga Gabriela, Boca Laura Otilia, Cojocaru Elena, Stârcea Iuliana Magdalena, Țarcă Elena, Scurtu Ana Maria, Mocanu Maria Adriana, Ioniuc Ileana, Tîrnovanu Mihaela Camelia, Trandafir Laura Mihaela

机构信息

Department of Mother and Child, Faculty of Medicine, University of Medicine and Pharmacy "Grigore T Popa", 700115 Iasi, Romania.

"Saint Mary" Emergency Hospital for Children, 700309 Iasi, Romania.

出版信息

Diagnostics (Basel). 2024 Aug 22;14(16):1832. doi: 10.3390/diagnostics14161832.

DOI:10.3390/diagnostics14161832
PMID:39202320
原文链接:https://pmc.ncbi.nlm.nih.gov/articles/PMC11353973/
Abstract

Celiac disease (CeD) is an enteropathy caused by the complex interaction between genetic, environmental, and individual immunological factors. Besides the hallmark of intestinal mucosal damage, CeD is a systemic disorder extending beyond the gastrointestinal tract and impacting various other organs, causing extraintestinal and atypical symptoms. The association between CeD and liver damage has been classified into three main categories: mild and asymptomatic liver injury, autoimmune liver injury, and liver failure. We present a case of severe liver damage with cirrhotic evolution in an obese 12-year-old boy who had been admitted due to generalized jaundice and localized abdominal pain in the right hypochondrium. In the course of investigating the etiology of severe liver disease, toxic, infectious, metabolic, obstructive, and genetic causes were excluded. Despite the patient's obesity, a diagnosis of CeD was established, and in accordance with autoimmune hepatitis (AIH) criteria, the patient was diagnosed with autoantibody-negative AIH associated to CeD.

摘要

乳糜泻（CeD）是一种由遗传、环境和个体免疫因素之间复杂相互作用引起的肠病。除了肠道黏膜损伤这一特征外，CeD还是一种全身性疾病，其影响范围超出胃肠道，累及其他多个器官，导致肠外症状和非典型症状。CeD与肝损伤的关联主要分为三大类：轻度无症状肝损伤、自身免疫性肝损伤和肝衰竭。我们报告了一例12岁肥胖男孩出现严重肝损伤并进展为肝硬化的病例，该男孩因全身黄疸和右季肋部局部腹痛入院。在调查严重肝病的病因过程中，排除了中毒、感染、代谢、梗阻和遗传等原因。尽管该患者肥胖，但仍确诊为CeD，并且根据自身免疫性肝炎（AIH）标准，该患者被诊断为与CeD相关且自身抗体阴性的AIH。

https://cdn.ncbi.nlm.nih.gov/pmc/blobs/9140/11353973/c4b705fa1daf/diagnostics-14-01832-g007.jpg
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本文引用的文献

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Liver Involvement in Children during the Diagnosis of Celiac Disease: A Single-Center Experience from Turkey.乳糜泻诊断过程中儿童的肝脏受累情况：来自土耳其的单中心经验
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Who to screen and how to screen for celiac disease.应当对哪些人进行筛查，以及如何进行乳糜泻筛查。
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Pivotal Role of Inflammation in Celiac Disease.炎症在乳糜泻中的关键作用。
Int J Mol Sci. 2022 Jun 28;23(13):7177. doi: 10.3390/ijms23137177.
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The Role of Intestinal Permeability in Gastrointestinal Disorders and Current Methods of Evaluation.肠道通透性在胃肠道疾病中的作用及当前评估方法
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High prevalence of celiac disease in autoimmune hepatitis: Systematic review and meta-analysis.自身免疫性肝炎中乳糜泻的高患病率：系统评价和荟萃分析。
Liver Int. 2021 Nov;41(11):2693-2702. doi: 10.1111/liv.15000. Epub 2021 Jul 29.
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Celiac Disease and Elevated Liver Enzymes: A Review.乳糜泻与肝酶升高：综述
J Clin Transl Hepatol. 2021 Feb 28;9(1):116-124. doi: 10.14218/JCTH.2020.00089. Epub 2020 Dec 7.
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Extra-Intestinal Manifestations of Coeliac Disease in Children: Clinical Features and Mechanisms.儿童乳糜泻的肠外表现：临床特征与机制
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Nutrients. 2018 Jun 12;10(6):755. doi: 10.3390/nu10060755.
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Global Prevalence of Celiac Disease: Systematic Review and Meta-analysis.全球乳糜泻患病率：系统评价和荟萃分析。
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Diagnosis and Management of Pediatric Autoimmune Liver Disease: ESPGHAN Hepatology Committee Position Statement.儿童自身免疫性肝病的诊断与管理：欧洲儿科胃肠病、肝病和营养学会肝病委员会立场声明
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