乳糜泻的胶囊内镜特点及临床诊治分析  

Analysis of capsule endoscopic features and clinical diagnosis and treatment of celiac disease

作　　者：姜炅[1] 王楚莹 伍洁[2] 蔡尚轩 王进海[1] 李红[1] 史海涛[1] JIANG Jiong;WANG Chuying;WU Jie;CAI Shangxuan;WANG Jinhai;LI Hong;SHI Haitao(Department of Gastroenterology,the Second Affiliated Hospital of Xi′an Jiaotong Univer-sity,Xi′an 710004,China;Department of Pathology,the Second Affiliated Hospital of Xi′an Jiaotong Univer-sity,Xi′an 710004,China)

机构地区：[1]西安交通大学第二附属医院消化内科,陕西西安710004 [2]西安交通大学第二附属医院病理科,陕西西安710004

出　　处：《胃肠病学和肝病学杂志》2023年第6期640-644,共5页Chinese Journal of Gastroenterology and Hepatology

基　　金：陕西省重点研发计划(2021SF-221)。

摘　　要：目的探讨乳糜泻的诊治特点及胶囊内镜下的典型表现,以期提高临床医师对该罕见疾病的深入认识。方法回顾性分析2018年1月至2021年12月于我院临床诊治的4例乳糜泻患者的临床资料。结果4例患者,男女各2例,发病年龄(34.0±8.4)岁,临床症状均表现为慢性腹泻,3例伴有腹痛。其中3例患者出现转氨酶升高,1例合并脂肪肝,1例合并亚临床甲减。血清学特异性抗体筛查发现4例患者EMA-IgA/IgG阳性,3例患者tTGA-IgA/IgG阳性,2例anti-DGP-IgA/IgG阳性。4例患者胶囊内镜均表现为不同程度绒毛短小、萎缩甚至消失,可见典型扇贝样或马赛克样皱襞。2例患者病变累及全小肠,十二指肠黏膜活检均符合乳糜泻病理改变。4例患者经无麸质饮食症状均有所改善,腹痛消失,腹泻次数明显减少。结论乳糜泻是一种易于漏诊的罕见疾病,临床医师应提高对本病的认识,减少漏诊与误诊。Objective To investigate the diagnostic and treatment characteristics of celiac disease and the typical manifestations of capsule endoscopy,with the aim of improving clinicians′in-depth understanding of this rare disease.Methods The clinical data of 4 patients with celiac disease who were clinically treated in our hospital from Jan.2018 to Dec.2021 were retrospectively analyzed.Results Four patients(2 males/2 females)with a mean age of onset of(34.0±8.4)years old presented.Diarrhea was the main clinical symptom of 4 patients.3 patients with abdominal pain.3 patients presented with elevated transaminases,1 patient combined with fatty liver and 1 patient combined with subclinical hypothyroidism.The serology-specific antibody screening revealed positive EMA-IgA/IgG in 4 patients,positive tTGA-IgA/IgG in 3 patients and positive anti-DGP-IgA/IgG in 2 patients.Capsule endoscopy in all 4 patients showed varying degrees of villi shortening,atrophy or even disappearance,with typical scallop-like or mosaic-like folds.2 patients had lesions involving the entire small intestine,and duodenal mucosal biopsies were consistent with the pathological diagnosis of celiac disease.All 4 patients showed improvement in symptoms with gluten free diet,disappearance of abdominal pain,and reduction in the number of diarrhea.Conclusion Celiac disease is a rare disease that is easy to be missed.Clinicians should improve their understanding of this disease and reduce missed diagnosis and misdiagnosis.

关 键 词：乳糜泻 慢性腹泻 临床表现 胶囊内镜 

分 类 号：R574[医药卫生—消化系统]