Dickey W, McMillan S A, Callender M E
Altnagelvin Hospital, Londonderry, Northern Ireland.
J Clin Gastroenterol. 1997 Jul;25(1):328-9. doi: 10.1097/00004836-199707000-00006.
Although coexisting primary biliary cirrhosis (PBC) and celiac sprue have been described, celiac sprue is sufficiently common in western Europe for chance to explain isolated cases. We screened our patients with PBC for celiac sprue using serum immunoglobulin A endomysial antibody (EmA), with confirmation by duodenal biopsy in EmA-positive patients. Of 57 patients, 6 (11%) had EmA. Four agreed to have a biopsy taken, and all had villous atrophy, yielding a minimum prevalence of 1:14 (7%). Apart from anemia in one patient, none of the four had symptoms or routine laboratory abnormalities suggestive of celiac sprue. None had improvement in liver biochemical tests after 12 to 24 months on gluten-free diets despite the disappearance of EmA. Celiac sprue is common among patients with PBC and they should be routinely screened for this condition. Symptoms wrongly attributed to PBC may respond to gluten exclusion, and both conditions are potent risk factors for osteoporosis.
尽管已有原发性胆汁性肝硬化（PBC）与乳糜泻同时存在的相关描述，但在西欧乳糜泻相当常见，因此偶然出现的孤立病例可以用此来解释。我们使用血清免疫球蛋白A肌内膜抗体（EmA）对原发性胆汁性肝硬化患者进行乳糜泻筛查，EmA阳性患者通过十二指肠活检进行确诊。57例患者中，6例（11%）EmA呈阳性。4例同意接受活检，结果均显示绒毛萎缩，最低患病率为1:14（7%）。除1例患者有贫血外，这4例患者均无提示乳糜泻的症状或常规实验室异常。尽管EmA消失，但4例患者在接受无麸质饮食12至24个月后，肝脏生化检查均未改善。乳糜泻在原发性胆汁性肝硬化患者中很常见，应对这类患者进行常规筛查。错误归因于原发性胆汁性肝硬化的症状可能对排除麸质有反应，而且这两种疾病都是骨质疏松症的重要危险因素。
