不同人种乳糜泻患者临床特征的单中心临床分析  

An analysis of clinical features of celiac disease patients in different ethnic

作　　者：耿伟[1] 乔旭柏[2] 纪开宇[1] 王厚芳[2] 杨爱明[3] 

机构地区：[1]北京和睦家医院消化内科,100015 [2]北京和睦家医院检验科,100015 [3]中国医学科学院北京协和医学院北京协和医院消化内科,100730

出　　处：《中华内科杂志》2016年第8期613-618,共6页Chinese Journal of Internal Medicine

摘　　要：目的 总结乳糜泻的临床表现、血清学及病理学特点,并分析欧美及东亚地区乳糜泻患者的异同,探讨中国人群乳糜泻的诊治现状及存在的问题.方法 收集2005年1月至2015年7月北京和睦家医院确诊的来自不同国家的87例乳糜泻患者资料,总结其国籍、发病年龄、临床表现、血清学抗体、内镜下表现、病理结果及治疗随访情况,并对来自不同国家的患者进行对比研究.结果 87例患者中,欧美患者63例（欧美组）,中国和日本患者18例（东亚组）,中东患者6例（中东组）.（1）从年龄构成看,乳糜泻发病的高峰年龄为40 - 60岁.（2）乳糜泻患者中,有慢性腹泻及体重减轻典型表现的患者仅分别占20.7％（18/87）和9.2％（8/87）;一部分患者表现为非特异性症状,如腹痛腹胀[32.2％ （28/87）],甚至便秘[5.7％ （5/87）];13.8％（12/87）患者既往曾被诊断为肠易激综合征（IBS）.欧美组和东亚组患者腹痛腹胀、腹泻、便秘症状的发生率的差异无统计学意义（P值均＞0.05）;但东亚组患者体重减轻、生长发育迟缓、缺铁性贫血、疱疹样皮炎的发生率明显高于欧美组（P值均＜0.05）.（3）IgA型抗麦胶蛋白抗体（AGA）、抗肌内膜抗体（EMA）和抗组织型谷氨酰胺转氨酶抗体（tTGA）在乳糜泻患者中的检出率较高,分别为58.6％ （51/87）、44.8％（39/87）与36.8％（32/87）.（4）消化内镜检查显示,乳糜泻的病变主要位于小肠,从近端小肠至远端小肠病变严重程度逐渐减轻.东亚组患者十二指肠球部、降部的黏膜病变表现较欧美组更为明显,病理组织学显示小肠黏膜萎缩及淋巴细胞增多程度也较欧美组更为严重.（5）87例患者全部接受了去麸质饮食（GFD）治疗,其中81例进行了血清学抗体随诊,8例进行了内镜下小肠黏膜活检的随诊.47例患者于GFD治疗后6-9个月全部血清抗体转阴,34例在12 - 18个月随访时血清抗Objective To summarize the clinical features of different racial patients with celiac disease （CD） and analyze the disease prevalence,diagnosis and treatment in Chinese population.Methods All the patients were diagnosed as CD and enrolled in Beijing United Family Hospital between January 2005 and July 2015.Clinical data including nationality,age,symptoms,endoscopic and pathological findings,outcome were collected and compared in patients from different countries.Results A total of 87 patients were enrolled including 63 Caucasians,18 Asian patients and 6 Middle East patients.The peak age of disease onset was 40-60 years old.Patients with typical symptoms such as chronic diarrhea and weight loss only accounted for 20.7% （18/87） and 9.2% （8/87） respectively.Some patients presented with nonspecific symptoms such as abdominal pain and bloating [32.2% （28/87）],even constipation [5.7% （5/87）].13.8% （12/87） patients were previously diagnosed as irritable bowel syndrome.The incidence of abdominal pain,bloating,diarrhea and constipation between Asians and Caucasians had no statistical significance （P 〉 0.05）;but the proportions of weight loss,growth retardation,iron deficiency anemia and dermatitis herpetiformis in Asian group were significantly higher than that in Caucasian group （P 〈 0.05）.IgA type of anti-gliadin antibody （AGA）,endomysium antibody （EMA） and tissue transglutaminase antibody （tTGA） were dominant autoimmune antibodies in patients with CD,which accounted for 58.6% （51/87）,44.8% （39/87） and 36.8% （32/87） respectively.The endoscopy showed that the lesion of CD was mainly located in small intestine,with reducing severity from the proximal to the distal small intestine.The lesions of duodenal bulb and descending duodenum appeared more significant in Asian group.Accordingly pathological intestinal atrophy and the degree of intraepithelial lymphocytosis were more severe in Asian patients.All 87 cases took the gluten-free diet （GFD）.Eighty-one cases r

关 键 词：乳糜泻 抗麦胶蛋白抗体 抗肌内膜抗体 抗组织型谷氨酰胺转氨酶抗体 去麸质饮食 

分 类 号：R574.62[医药卫生—消化系统]