Liver involvement in celiac disease
Liver involvement in celiac disease
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乳糜泻中肝脏受累
DOI：
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发表时间：
2006
影响因子：
4.3
通讯作者：
S. Caprai
中科院分区：
文献类型：
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作者：
G. Maggiore;S. Caprai
乳糜泻可能表现为一种隐源性肝脏疾病，在5-10%的患者中发现，血清转氨酶活性持续和隐源性升高。事实上，儿童和成人中广泛的肝损伤可能与CD相关，特别是：（1）轻度实质损伤，特征为无任何提示慢性肝病的临床体征或症状，以及无麸质饮食可逆的非特异性组织学变化;（2）自身免疫机制的慢性炎性肝损伤，包括自身免疫性肝炎、原发性硬化性胆管炎和原发性胆汁性肝硬化，这可能导致纤维化和肝硬化，通常不受麸质戒断的影响，需要免疫抑制治疗;（3）严重的肝衰竭，可能通过无麸质饮食治疗。这种不同类型的肝损伤可能代表了同一种疾病的一个谱，其中个体因素，如遗传易感性，早熟和暴露于麸质的持续时间可能会影响肝损伤的可逆性。建议对CD个体中的无症状肝损伤进行严格的交叉检查，反之，对任何隐源性肝病（包括终末期肝衰竭）中的CD进行严格的交叉检查。
Celiac disease may present as a cryptogenic liver disorder being found in 5–10% of patients with a persistent and cryptogenetic elevation of serum aminotransferase activity. In fact, a wide spectrum of liver injuries in children and adults may be related to CD and in particular: (1) a mild parenchymal damage characterised by absence of any clinical sign or symptom suggesting a chronic liver disease and by non-specific histological changes reversible on a gluten-free diet; (2) a chronic inflammatory liver injury of autoimmune mechanism, including autoimmune hepatitis, primary sclerosing cholangitis and primary biliary cirrhosis, that may lead to fibrosis and cirrhosis, generally unaffected by gluten withdrawal and necessitating an immunosuppressive treatment; (3) a severe liver failure potentially treatable by a gluten-free diet. Such different types of liver injuries may represent a spectrum of a same disorder where individual factors, such as genetic predisposition, precocity and duration of exposure to gluten may influence the reversibility of liver damage. A rigorous cross-checking for a asymptomatic liver damage in CD individuals and conversely, for CD in any cryptogenic liver disorder including end-stage liver failure is recommended.