Clinical findings and anti-neuronal antibodies in coeliac disease with neurological disorders
Clinical findings and anti-neuronal antibodies in coeliac disease with neurological disorders
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DOI：
10.1080/003655202761020542
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发表时间：
2002-11-01
影响因子：
1.9
通讯作者：
Bianchi, FB
中科院分区：
文献类型：
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作者：
Volta, U;De Giorgio, R;Bianchi, FB
背景：对伴有神经功能障碍的乳糜泻患者的临床和免疫学特征知之甚少。在一大系列的成年乳糜泻患者中，我们调查了神经性疾病和抗神经元抗体的患病率以及临床病程。方法：对160例经活检证实的腹部疾病患者(女性120例，男性40例)进行神经症状调查。对所有神经科患者、20名未发病患者和20名对照组进行了中枢神经/肠神经系统抗神经元抗体检测。结果：神经功能障碍13例(8%)，其中癫痫3例，注意力/记忆障碍3例，小脑性共济失调2例，周围神经病变2例，多发性硬化症1例，烟雾病1例，Steinert病1例。在有神经受累和没有神经受累的患者之间，没有发现显著的人口统计学或临床差异(胃肠道或其他面筋相关体征)。在13例中，除2例外，所有患者的神经功能障碍都在被诊断为乳糜泻之前。神经症状改善或消失的患者中，有7名患者在神经疾病发作后6个月内开始无麸质饮食，而4名患者在之后开始饮食，没有一名患者的神经症状得到改善或消失。神经科患者中枢神经系统抗神经元抗体阳性率(61%)显著高于其他患者(5%)(P=0.0007)和对照组(0%)(P=0.00001)。结论：乳糜泻有时会以神经系统疾病的名义出现，如果及时开始无麸质饮食，这种疾病可能会得到极大改善。因此，在患有小脑性共济失调、癫痫、注意力/记忆障碍或周围神经病的患者中，需要仔细考虑可能存在的乳糜泻。
Background: Little is known about the clinical and immunological features of coeliac disease patients with neurological disorders. In a large series of adult coeliac disease patients, we investigated the prevalence of neurological disorders and anti-neuronal antibodies, along with the clinical course. Methods: Neurological symptoms were investigated in 160 consecutive patients (120 F, 40 M) with biopsy-proven coeliac disease. Anti-neuronal antibodies to central/enteric nervous systems were investigated in all neurological patients, 20 unaffected ones and 20 controls. Results: Thirteen (8%) patients had neurological disorders, including epilepsy (n = 3), attention/memory impairment (n = 3), cerebellar ataxia (n = 2), peripheral neuropathy (n = 2), multiple sclerosis (n = 1), Moyamoya disease (n = 1) and Steinert's disease (n = 1). No significant demographic or clinical differences (gastrointestinal or other gluten-related signs) were found between patients with and without neurological involvement. In all but 2 of the 13 cases, the neurological disorder preceded diagnosis of coeliac disease. Neurological symptoms improved or disappeared in 7 patients who started a gluten-free diet within 6 months after neurological onset, and in none of 4 patients who began later. Prevalence of central nervous system anti-neuronal antibodies was significantly higher in neurological (61%) than in other patients (5%) (P = 0.0007) or controls (0%) (P = 0.00001). Conclusions: Coeliac disease can sometimes present in the guise of a neurological disorder, which may greatly improve when a gluten-free diet is started promptly. Therefore, the possible presence of coeliac disease needs to be carefully considered in patients with cerebellar ataxia, epilepsy, attention/memory impairment or peripheral neuropathy.