Arranz E, Ferguson A
Gastrointestinal Unit, University of Edinburgh, Scotland.
Gastroenterology. 1993 May;104(5):1263-72. doi: 10.1016/0016-5085(93)90333-8.
Patients with celiac disease have immunoglobulin (Ig) M antibodies and IgA antigliadin antibody in gut secretions; this pattern of intestinal immunity may be a marker of latent celiac disease. Its frequency in patients referred for jejunal biopsy has been examined.
Serum IgG and IgA antigliadin antibody, jejunal fluid IgA and IgM antibodies to gliadin, ovalbumin and beta lactoglobulin, and jejunal fluid IgA and IgM concentrations were measured by enzyme-linked immunosorbent assay.
Seventeen of 19 celiac patients on normal diet and 16 of 23 on gluten-free diet had the celiaclike antibody pattern, as did 41 of 217 other patients. Jejunal biopsy histology had been classified as normal in 38 of these, with minor abnormalities in 3; however, intraepithelial lymphocyte (IEL) counts were high in 13 cases. Trial of a gluten-free diet produced clinical improvement in 6 of 7 antibody-positive patients. After extra dietary gluten, one developed subtotal villous atrophy.
The celiaclike intestinal antibody pattern and a high IEL count may be markers of latent gluten-sensitive enteropathy; some of these patients are clinically gluten sensitive in the absence of enteropathy.
乳糜泻患者肠道分泌物中有免疫球蛋白（Ig）M抗体和IgA抗麦醇溶蛋白抗体；这种肠道免疫模式可能是潜在乳糜泻的一个标志。已对因空肠活检而转诊的患者中其出现频率进行了检查。
采用酶联免疫吸附测定法检测血清IgG和IgA抗麦醇溶蛋白抗体、空肠液中针对麦醇溶蛋白、卵清蛋白和β-乳球蛋白的IgA和IgM抗体，以及空肠液中IgA和IgM的浓度。
19例正常饮食的乳糜泻患者中有17例、23例无谷蛋白饮食的患者中有16例具有类似乳糜泻的抗体模式，217例其他患者中有41例也有此模式。其中38例空肠活检组织学分类为正常，3例有轻微异常；然而，13例患者的上皮内淋巴细胞（IEL）计数较高。7例抗体阳性患者中有6例采用无谷蛋白饮食试验后临床症状改善。额外摄入谷蛋白后，1例出现了部分绒毛萎缩。
类似乳糜泻的肠道抗体模式和高IEL计数可能是潜在谷蛋白敏感性肠病的标志；这些患者中有一些在无肠病的情况下临床上对谷蛋白敏感。
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