Kluge F, Koch H K, Köttgen E, Gerok W
Klin Wochenschr. 1983 Jul 15;61(14):669-79. doi: 10.1007/BF01487612.
The corn protein gluten causes the gluten-sensitive enteropathy in susceptible persons (HLA-antigens). The diagnosis is made on the basis of the morphological criteria of villous atrophy of the jejunal mucosa and the clinical observation that the malabsorption can be healed by a gluten-free diet. The disease, which occurs in children and adults, is a distinct entity. Life-long adherence to a gluten-free diet is difficult. Intentional or unintentional reintroduction of gluten often causes masked disease states. These are best classified on the basis of electron-microscopy study of the jejunal biopsy. We propose a new classification of the phases of remission. A group of diseases exist which are closely related to gluten-sensitive enteropathy. Frequently villous atrophy is detectable. However, the disease does not respond to a gluten-free diet. The pathophysiology of these diseases is at present unclear. Diseases involving autoimmune processes also appear to be associated with gluten-sensitive enteropathy. The common factor is probably an immuno-genetic defect. This is supported by the existence of common HLA-antigen constellations. Gluten has been characterised in vitro as a lectin with oligomannose specificity. This provides a new pathomechanism for the gluten induced enterocytic destruction.
玉米蛋白麸质会在易患人群（HLA抗原）中引发麸质敏感性肠病。诊断基于空肠黏膜绒毛萎缩的形态学标准以及临床观察，即无麸质饮食可治愈吸收不良。这种疾病在儿童和成人中均有发生，是一种独特的病症。终生坚持无麸质饮食颇具难度。有意或无意重新摄入麸质往往会引发隐匿的疾病状态。这些状态最好通过空肠活检的电子显微镜研究进行分类。我们提出了一种缓解期阶段的新分类方法。存在一组与麸质敏感性肠病密切相关的疾病。通常可检测到绒毛萎缩。然而，这些疾病对无麸质饮食无反应。目前这些疾病的病理生理学尚不清楚。涉及自身免疫过程的疾病似乎也与麸质敏感性肠病相关。共同因素可能是免疫遗传缺陷。常见HLA抗原组合的存在支持了这一点。麸质在体外已被表征为具有低聚甘露糖特异性的凝集素。这为麸质诱导的肠细胞破坏提供了一种新的发病机制。
