Michaëlsson G, Kraaz W, Gerdén B, Hagforsen E, Hjelmqvist G, Lööf L, Sjöberg O, Scheynius A
Department of Dermatology, University Hospital, Uppsala, Sweden.
Br J Dermatol. 1995 Dec;133(6):896-904. doi: 10.1111/j.1365-2133.1995.tb06922.x.
In a screening study concerning IgA and IgG antibodies to gliadin (IgA AGA and IgG AGA, respectively) in psoriasis, raised levels of IgA and AGA were found to be more common than in a reference group. To determine whether elevated AGA levels were associated with an increased number of intraepithelial lymphocytes, 33 patients with IgA AGA (n = 28) or IgG AGA (n = 5) values above 90% of the reference values (> 50 units/ml IgA AGA and < 12 units/ml IgG AGA) underwent gastroduodenoscopy and duodenal biopsy in a prospective study. For comparison, six patients with low levels of both IgA AGA and IgG AGA were included. Five biopsy specimens were taken in each patient. Paraffin-embedded specimens were examined with regard to the degree of intraepithelial lymphocyte infiltration, and scored from 0 to 3. Biopsy specimens with a score of 0 had one mononuclear cell or less per four epithelial cells. The specimens were also examined with regard to the presence of intraepithelial CD3+ T lymphocytes and gamma/delta+ T lymphocytes. In the six patients with low IgA AGA and low IgG AGA, the biopsy score was 0. Fourteen of the 33 patients with raised AGA had a score of > or = 1; of these, 12 had raised IgA AGA and two had slightly raised IgG AGA. Two of the patients with raised IgA AGA had partial villous atrophy, but the majority had normal villous architecture. There was a significant correlation both between the biopsy score and the number of intraepithelial CD3+ cells and between the score and the number of intraepithelial gamma/delta+ positive T lymphocytes. The serum IgA AGA levels were significantly correlated with the duodenal biopsy score, the number of intraepithelial gamma/delta+ T lymphocytes, and the number of CD3+ intraepithelial T lymphocytes. Most patients had no, or only mild, gastrointestinal symptoms. Of the 14 patients with biopsy scores > or = 1, seven had severe psoriasis and five moderately severe psoriasis, whereas only two had mild psoriasis. There was no relationship between the duodenal score and haemoglobin, folate, whole blood selenium or serum zinc levels. Some of these patients improve on a gluten-free diet, but it is still too early to draw any definite conclusions concerning the type of relationship between the skin lesions, the increased number of intraepithelial lymphocytes in the duodenal mucosa and gluten hypersensitivity.
在一项关于银屑病患者中抗麦醇溶蛋白IgA和IgG抗体（分别为IgA AGA和IgG AGA）的筛查研究中，发现IgA和AGA水平升高的情况比参照组更为常见。为了确定AGA水平升高是否与上皮内淋巴细胞数量增加有关，在一项前瞻性研究中，对33例IgA AGA（n = 28）或IgG AGA（n = 5）值高于参照值90%（>50单位/ml IgA AGA且<12单位/ml IgG AGA）的患者进行了胃十二指肠镜检查和十二指肠活检。作为对照，纳入了6例IgA AGA和IgG AGA水平均较低的患者。每位患者取5份活检标本。对石蜡包埋标本的上皮内淋巴细胞浸润程度进行检查，并从0至3分进行评分。评分为0的活检标本每4个上皮细胞中有1个或更少的单核细胞。还对标本中上皮内CD3 + T淋巴细胞和γ/δ + T淋巴细胞的存在情况进行了检查。在IgA AGA和IgG AGA水平均较低的6例患者中，活检评分为0。在33例AGA水平升高的患者中，14例评分≥1分；其中，12例IgA AGA升高，2例IgG AGA略有升高。2例IgA AGA升高的患者有部分绒毛萎缩，但大多数患者绒毛结构正常。活检评分与上皮内CD3 +细胞数量之间以及评分与上皮内γ/δ +阳性T淋巴细胞数量之间均存在显著相关性。血清IgA AGA水平与十二指肠活检评分、上皮内γ/δ + T淋巴细胞数量以及上皮内CD3 + T淋巴细胞数量均显著相关。大多数患者没有或仅有轻微的胃肠道症状。在14例活检评分≥1分的患者中，7例患有重度银屑病，5例患有中度重度银屑病，而只有2例患有轻度银屑病。十二指肠评分与血红蛋白、叶酸、全血硒或血清锌水平之间没有关系。这些患者中的一些人在无麸质饮食后病情有所改善，但就皮肤病变、十二指肠黏膜上皮内淋巴细胞数量增加与麸质超敏反应之间的关系类型得出任何明确结论仍为时过早。
