Volta U, De Franceschi L, Lari F, Molinaro N, Zoli M, Bianchi F B
Department of Internal Medicine Cardioangiology, Hepatology, University of Bologna, Policlinic S Orsola-Malpighi, Italy.
Lancet. 1998 Jul 4;352(9121):26-9. doi: 10.1016/s0140-6736(97)11222-3.
Hypertransaminasaemia of unknown, cryptogenic, origin occasionally has been found to be the only sign of coeliac disease. Raised concentrations of transaminases, or aminotransferases, have been retrospectively observed in about a half of patients with coeliac disease who are on a gluten-containing diet. We aimed to establish the overall prevalence of coeliac disease among patients with cryptogenic hypertransaminasaemia.
Of the 600 consecutive patients referred to our outpatient clinic for liver disease due to raised serum transaminases from September, 1995, to June, 1997, 55 were classified as having cryptogenic hypertransaminasaemia after the exclusion of every known cause of liver disease. These patients were tested by indirect immunofluorescence for IgA to endomysium and for IgA and IgG to gliadin.
Five patients were positive for both IgA to endomysium and IgG to gliadin, whereas IgA to gliadin was only found in four patients. IgG to gliadin was also present in another patient who was not positive for antibodies to endomysium. The six antibody-positive patients had duodenal biopsy that showed a subtotal villous atrophy consistent with coeliac disease in the five patients with antibodies to endomysium. The patient with only IgG to gliadin had a normal small-intestine mucosa. None of the five patients with coeliac disease had gastrointestinal symptoms. Liver biopsy samples were taken from three of the five patients with flat mucosa and showed a histological picture of nonspecific reactive hepatitis. Transaminase concentrations reverted to normal within 6 months in four patients with coeliac disease who followed a strict gluten-free diet.
Our results show that about 9% of patients with cryptogenic hypertransaminasaemia are affected by symptom-free coeliac disease. Gluten-sensitive enteropathy and antibody screening for coeliac disease by means of antibodies to endomysium and gliadin should be considered in these patients.
不明原因的隐源性高转氨酶血症偶尔被发现是乳糜泻的唯一症状。在约一半食用含麸质饮食的乳糜泻患者中，曾回顾性观察到转氨酶或氨基转移酶浓度升高。我们旨在确定隐源性高转氨酶血症患者中乳糜泻的总体患病率。
1995年9月至1997年6月期间，因血清转氨酶升高而转诊至我们门诊肝病科的600例连续患者中，排除所有已知肝病病因后，55例被归类为隐源性高转氨酶血症。这些患者通过间接免疫荧光法检测抗肌内膜IgA以及抗麦醇溶蛋白IgA和IgG。
5例患者抗肌内膜IgA和抗麦醇溶蛋白IgG均呈阳性，而仅4例患者抗麦醇溶蛋白IgA呈阳性。另1例抗肌内膜抗体阴性患者也存在抗麦醇溶蛋白IgG。6例抗体阳性患者接受十二指肠活检，5例抗肌内膜抗体阳性患者显示符合乳糜泻的不完全性绒毛萎缩。仅抗麦醇溶蛋白IgG阳性的患者小肠黏膜正常。5例乳糜泻患者均无胃肠道症状。5例黏膜扁平患者中的3例接受肝活检，显示非特异性反应性肝炎的组织学表现。4例遵循严格无麸质饮食的乳糜泻患者转氨酶浓度在6个月内恢复正常。
我们的结果表明，约9%的隐源性高转氨酶血症患者患有无症状乳糜泻。对于这些患者，应考虑麸质敏感性肠病以及通过抗肌内膜和抗麦醇溶蛋白抗体筛查乳糜泻。
