Does cryptic gluten sensitivity play a part in neurological illness?
Does cryptic gluten sensitivity play a part in neurological illness?
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DOI：
10.1016/s0140-6736(96)90540-1
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发表时间：
1996-02-10
期刊：
影响因子：
168.9
通讯作者：
MilfordWard, A
中科院分区：
文献类型：
--
作者：
Hadjivassiliou, M;Gibson, A;MilfordWard, A
背景 抗麦胶蛋白抗体是未经治疗的乳糜泻的标志物，但也可以在具有正常小肠粘膜的个体中发现。由于神经功能障碍是乳糜泻的一种已知并发症，我们研究了抗麦胶蛋白抗体的频率（作为隐性麸质敏感性的衡量标准）和神经系统患者的乳糜泻。方法使用 ELISA，我们评估了 147 名神经系统患者的血清 IgG 和 IgA 抗麦胶蛋白抗体，这些患者分为两组。尽管进行了全面调查，仍有 53 例患者出现原因不明的神经功能障碍（25 例共济失调、20 例周围神经病、5 例多发性单神经炎、4 例肌病、3 例运动神经病、2 例脊髓病）。其余 94 名患者被发现有特定的神经学诊断（16 名中风、12 名多发性硬化症、10 名帕金森病、56 名其他诊断）并形成神经学对照组。 50 名健康献血者组成第三组。结果 三组中抗麦醇溶蛋白抗体滴度呈阳性的个体比例分别为 30/53、5/94 和 6/50（57%、5% 和 12%）。第 1 组和联合对照组之间的比例差异为 0.49 (95% CI 0.35-0.63)。第 1 组 30 名抗麦胶蛋白阳性患者中，有 26 名患者进行远端十二指肠活检，结果显示 9 名 (35%) 患者有乳糜泻，10 名 (38%) 患者有非特异性十二指肠炎，7 名 (26%) 患者无病变。 解释 我们的数据表明，麸质敏感性在原因不明的神经系统疾病患者中很常见，可能具有病因学意义。
Background Antigliadin antibodies are a marker of untreated coeliac disease but can also be foun in individuals with normal small-bowel mucosa. Because neurological dysfunction is a known complication of coeliac disease we have investigated the frequency of antigliadin antibodies, as a measure of cryptic gluten sensitivity, and coeliac disease in neurological patients.Methods Using ELISA, we estimated serum IgG and IgA antigliadin antibodies in 147 neurological patients who were divided into two groups. There were 53 patients with neurological dysfunction of unknown cause despite full investigation (25 ataxia, 20 peripheral neuropathy, 5 mononeuritis multiplex, 4 myopathy, 3 motor neuropathy, 2 myelopathy). The remaining 94 patients were found to have a specific neurological diagnosis (16 stroke, 12 multiple sclerosis, 10 Parkinson's disease, 56 other diagnoses) and formed the neurological control group. 50 healthy blood donors formed a third group.Findings The proportions of individuals with positive titres for antigliadin antibodies in the three groups were 30/53, 5/94, and 6/50 respectively (57, 5, and 12%). The difference in proportion between group 1 and the combined control groups was 0.49 (95% CI 0.35-0.63). Distal duodenal biopsies in 26 out of 30 antigliadin-positive patients from group 1 revealed histological evidence of coeliac disease in nine (35%), non-specific duodenitis in ten (38%), and no lesion in seven (26%) individuals.Interpretation Our data suggest that gluten sensitivity is common in patients with neurological disease of unknown cause and may have aetiological significance.