Federation of international societies of pediatric gastroenterology, hepatology, and nutrition consensus report on celiac disease
Federation of international societies of pediatric gastroenterology, hepatology, and nutrition consensus report on celiac disease
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DOI：
10.1097/mpg.0b013e318181afed
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发表时间：
2008-08-01
影响因子：
2.9
通讯作者：
Phillips, A.
中科院分区：
文献类型：
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作者：
Fasano, A.;Araya, M.;Phillips, A.
乳糜泻(CD)是一种面筋敏感型、免疫介导型慢性肠病，具有多种不同严重程度的表现。它是由小麦面筋中的醇溶蛋白部分以及大麦和黑麦中类似的醇溶蛋白(醇溶蛋白)在遗传易感对象中摄入而引发的。随后的免疫反应会导致小肠炎和绒毛萎缩。坚持无麸质饮食(GFD)之后是绒毛结构的改善或正常化。CD代表一种“独特的”自身免疫性疾病，因为触发免疫反应(面筋)的环境因素是已知的。Cd不仅影响肠道，而且是一种全身性疾病，可能会对肠道外器官造成损害。人类白细胞抗原(人类白细胞抗原)状态似乎是腹腔自身免疫风险的最强遗传决定因素，因为特定的人类白细胞抗原II类等位基因在面筋呈递给T细胞中起着作用。在受影响的个体中，95%的人携带DQ2(人类白细胞抗原DQA1-05-DQB1 02)或DQ8(HLADQA1 03-DQB1 0302)，而普通人群中约有30%至35%的人携带DQ2或DQ8(1，2)。除了人类白细胞抗原II类基因外，还有证据表明位于第2染色体(2q33)、第5染色体(5q31-q33)和第19染色体(19p13)上的其他基因也参与其中。1)，且在白介素2(IL-2)和白介素21(IL-21)(3–6).ThetrueprevalenceofCDisdifficulttoestimatebecause的区域有其可变的临床表现，许多患者可以有很少的或没有症状。随着人们对其临床复杂性的更好认识，以及敏感和特异的筛查试验的可获得性，CD现在被认为是一个全球公共卫生问题。CD影响多达0.5%至1.0%的欧洲或欧洲血统人口，但大多数病例仍未得到诊断(7-11)。
Celiac disease (CD) is a gluten-sensitive, immunemediated chronic enteropathy with a wide range of manifestations of variable severity. It is triggered by the ingestion of gliadin fractions of wheat gluten and similar alcohol-soluble proteins (prolamines) of barley and rye in genetically susceptible subjects. The subsequent immune reaction leads to small bowel inflammation and villous atrophy. Adherence to a gluten-free diet (GFD) is followed by amelioration or normalization of the villous architecture. CD represents a ‘‘unique’’autoimmune disease in that the environmental factor triggering the immune response (gluten) is known. CD not only affects the gut but is also a systemic disease that may cause injury to extraintestinal organs as well. Human leukocyte antigen (HLA) status appears to be the strongest genetic determinant of risk for celiac autoimmunity, because of the role that specific HLA class II alleles play in the presentation of gluten to T cells. Of the affected individuals, 95% have either DQ2 (HLA-DQA1Ã05-DQB1Ã02) or DQ8 (HLADQA1Ã03-DQB1Ã0302), in comparison with the general population in which about 30% to 35% have either DQ2 or DQ8 (1, 2). Besides HLA II class genes, there is evidence for involvement of other genes located on chromosomes 2 (2q33), 5 (5q31-q33), and 19 (19p13. 1), and in the region harboring interleukin-2 (IL-2) and IL-21 (3–6).ThetrueprevalenceofCDisdifficulttoestimatebecause of its variable clinical presentation, and many patients can have few or no symptoms. With a better appreciation of its clinical complexity and the availability of sensitive and specific screening tests, CD is now considered a public health problem worldwide. CD affects as much as 0.5% to 1.0% of European or European ancestry populations, but most cases remain undiagnosed (7–11).