Catassi C, Rätsch I M, Fabiani E, Rossini M, Bordicchia F, Candela F, Coppa G V, Giorgi P L
Department of Pediatrics, University of Ancona, Italy.
Lancet. 1994 Jan 22;343(8891):200-3. doi: 10.1016/s0140-6736(94)90989-x.
It is now generally believed that subclinical coeliac disease is common in the general population. We have undertaken screening for this disorder in a school district in central Italy. Screening was divided into three levels: first, IgG and IgA antigliadin antibody (AGA) assay on capillary blood obtained by finger prick; second, AGA plus IgA anti-endomysium antibody (AEA) test and measurement of serum immunoglobulins in venous blood; and third, intestinal biopsy. 3351 students (66% of the eligible population) aged 11-15 years attended first-level screening. 71 (2%) were recalled because of AGA positivity; 18 of these satisfied second-level criteria and underwent intestinal biopsy. Coeliac disease was diagnosed in 11 subjects, most of whom had no serious symptoms. Selective IgA deficiency was found in 4 subjects, 1 of whom also had coeliac disease. The prevalence of subclinical coeliac disease in the study group was 3.28 per 1000. Coeliac disease screening is feasible and involves only slight discomfort to the general population. Such screening can detect large numbers of cases of coeliac disease, which can be treated with a gluten-free diet. Many subclinical cases of coeliac disease would not be detected by screening only a selected group of at-risk patients.
现在普遍认为，亚临床乳糜泻在普通人群中很常见。我们在意大利中部的一个学区对这种疾病进行了筛查。筛查分为三个级别：第一，对手指采血获得的毛细血管血进行IgG和IgA抗麦胶蛋白抗体（AGA）检测；第二，AGA检测加IgA抗肌内膜抗体（AEA）检测以及静脉血中血清免疫球蛋白的测定；第三，肠道活检。3351名11至15岁的学生（占符合条件人群的66%）参加了一级筛查。71人（2%）因AGA阳性被召回；其中18人符合二级标准并接受了肠道活检。11名受试者被诊断为乳糜泻，其中大多数没有严重症状。4名受试者被发现有选择性IgA缺乏，其中1人也患有乳糜泻。研究组中亚临床乳糜泻的患病率为每1000人中有3.28例。乳糜泻筛查是可行的，对普通人群只会造成轻微不适。这样的筛查可以发现大量乳糜泻病例，这些病例可以通过无麸质饮食进行治疗。仅对选定的一组高危患者进行筛查，许多亚临床乳糜泻病例将无法被检测到。
