Premate F M
I Clinica Pediatrica, Università di Roma.
Clin Ter. 1996 Oct;147(10):495-503.
Recent studies have been reported for coeliac disease a new prevalence: 1:200 in Europe, 1:184 in Italy. These improvements have been possible for new diagnostic methods and techniques available today: antigliadin, antireticulin and antiendomysium antibodies. These serologic markers have been detected, in recent advances, new clinical presentations for coeliac disease: not only typical gastrointestinal symptoms (diarrhea, recurrent abdominal pain, etc), but many atypical symptoms have been described: sideropenic anemia, short stature, growth retardation, dermatitis herpetiformis, small alterations, alopecia, etc. New groups of patients have been also identified: some patients, clinically asymptomatic, with positive serology and a small intestinal biopsy suggestive for coeliac disease; they have shown histopathologic improvement with gluten free diet ("silent" coeliac disease). Another interesting group consists of asymptomatic patients with a positive serology for AGA and AEA antibodies, but normal gastrointestinal biopsy with free diet; they develop later in life, mucosal atrophy and normalization after gluten free diet ("latent" coeliac disease). It must be emphasized that classes of antibodies (in association with peroneal biopsy) have been identified in the last years, new clinical presentations of coeliac disease and new associations with other autoimmune pathologies.
在欧洲为1:200，在意大利为1:184。如今有了新的诊断方法和技术，这些进展才得以实现：抗麦胶蛋白抗体、抗网硬蛋白抗体和抗肌内膜抗体。在最近的研究进展中，已检测到这些血清学标志物与乳糜泻的新临床表现有关：不仅有典型的胃肠道症状（腹泻、反复腹痛等），还描述了许多非典型症状：缺铁性贫血、身材矮小、生长发育迟缓、疱疹样皮炎、细微改变、脱发等。还识别出了新的患者群体：一些患者临床无症状，血清学检查呈阳性，小肠活检提示乳糜泻；他们在采用无麸质饮食后组织病理学有改善（“隐匿性”乳糜泻）。另一个有趣的群体由血清学检查抗麦胶蛋白抗体和抗肌内膜抗体呈阳性但胃肠道活检正常且饮食正常的无症状患者组成；他们在晚年出现黏膜萎缩，采用无麸质饮食后恢复正常（“潜伏性”乳糜泻）。必须强调的是，在过去几年中已识别出各类抗体（与腓肠活检相关）、乳糜泻的新临床表现以及与其他自身免疫性疾病的新关联。
