网状纤维或麦醇溶蛋白抗体阳性但无绒毛萎缩患者的小肠黏膜炎症。

Small-bowel mucosal inflammation in reticulin or gliadin antibody-positive patients without villous atrophy.

作者信息

Kaukinen K, Collin P, Holm K, Karvonen A L, Pikkarainen P, Mäki M

机构信息

Dept. of Medicine and Paediatrics, Tampere University Hospital, Medical School, and Institute of Medical Technology, University of Tampere, Finland.

出版信息

Scand J Gastroenterol. 1998 Sep;33(9):944-9. doi: 10.1080/003655298750026967.

DOI:10.1080/003655298750026967

PMID:9759950

Abstract

BACKGROUND

We investigated whether individuals with positive coeliac disease antibodies but without small-bowel villous atrophy have mucosal inflammation implicating gluten-sensitivity.

METHODS

Small-bowel mucosal morphology; CD3+, alphabeta+, and gammadelta+ T-cell receptor-bearing intraepithelial lymphocytes; and mucosal HLA-DR expression were studied in 96 IgA-class antireticulin or antigliadin antibody-positive adults suspected of having coeliac disease and in 27 control subjects.

RESULTS

Villous atrophy compatible with coeliac disease was found in altogether 29 patients, in 18 of 21 (86%) patients with both antireticulin and antigliadin antibodies, in 9 of 15 (60%) patients with antireticulin antibodies only, and in 2 of 60 (3%) with antigliadin antibodies only. In 67 antibody-positive patients with normal villous architecture the densities of CD3+, alphabeta+, and gammadelta+ intraepithelial lymphocytes were significantly higher than in non-coeliac control subjects. Ten patients with initially increased densities of gammadelta+ T cells but normal villous structure underwent a follow-up biopsy after 4-18 months, which showed villous atrophy in five patients.

CONCLUSIONS

IgA-class antireticulin or antigliadin antibody-positive patients with normal small-bowel mucosal morphology frequently have immunohistochemical markers of coeliac disease latency. Together with our follow-up data this implies that they may be gluten-sensitive.

摘要

背景

我们研究了患有乳糜泻抗体阳性但无小肠绒毛萎缩的个体是否存在提示麸质敏感性的黏膜炎症。

方法

对96名疑似患有乳糜泻的IgA类抗网硬蛋白或抗麦醇溶蛋白抗体阳性成年人以及27名对照受试者进行了小肠黏膜形态学、携带CD3⁺、αβ⁺和γδ⁺T细胞受体的上皮内淋巴细胞以及黏膜HLA-DR表达的研究。

结果

总共在29名患者中发现了与乳糜泻相符的绒毛萎缩，在21名同时具有抗网硬蛋白和抗麦醇溶蛋白抗体的患者中有18名（86%），在仅具有抗网硬蛋白抗体的15名患者中有9名（60%），在仅具有抗麦醇溶蛋白抗体的60名患者中有2名（3%）。在67名绒毛结构正常的抗体阳性患者中，CD3⁺、αβ⁺和γδ⁺上皮内淋巴细胞的密度显著高于非乳糜泻对照受试者。10名最初γδ⁺T细胞密度增加但绒毛结构正常的患者在4 - 18个月后接受了随访活检，其中5名患者出现了绒毛萎缩。