CLINICAL AND PATHOLOGICAL SPECTRUM OF CELIAC-DISEASE ACTIVE, SILENT, LATENT, POTENTIAL
CLINICAL AND PATHOLOGICAL SPECTRUM OF CELIAC-DISEASE ACTIVE, SILENT, LATENT, POTENTIAL
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DOI：
10.1136/gut.34.2.150
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发表时间：
1993-02-01
期刊：
影响因子：
24.5
通讯作者：
OMAHONY, S
中科院分区：
文献类型：
--
作者：
FERGUSON, A;ARRANZ, E;OMAHONY, S
在当前定义的框架内(一种永久性的面筋过敏性肠病)，临床、病理学、流行病学和免疫学方法揭示了几种形式的乳糜泻。在所谓的活动性乳糜泻中，吸收不良和营养缺乏从严重到轻微不等；临床上无症状的乳糜泻正越来越多地被认识到--例如，在家庭研究中。在病理上，也存在一定程度的异质性。“扁平粘膜”或“次全绒毛萎缩”等描述性术语是病理学家对一系列特征(绒毛、隐窝大小、上皮细胞损伤、上皮内和固有层淋巴细胞浸润物)的缩写，这些特征共同描述了乳糜泻的肠道疾病。定量组织学和计算机图像分析表明，这些特征是连续发生的，一端是扁平病变，另一端是正常绒毛和隐窝结构的粘膜，但另一端绒毛上皮内淋巴细胞密度或计数异常高。2后者被大多数临床病理学家认为是正常的。这一事实是重要的，当审查的证据存在的潜伏性乳糜泻。这一术语只适用于满足以下条件的患者：(I)在正常饮食的同时进行正常的空肠活检；(Ii)在其他时间，在之前或之后，进行了平坦的空肠活检，并在无麸质饮食下恢复。温斯坦最先提出了可能存在“乳沟前期”状态的建议，他描述了两名患有疱疹样皮炎和正常空肠活检的患者，在他们已经含有面筋的饮食中添加了20克面筋后，几周后出现了典型的乳糜泻样肠病。3来自联合王国的两项研究证实了这一观点45，这一概念得到了腹部病人病例报告的支持，这些病人以前偶然接受过空肠活组织检查，并被报告为正常。
Within the framework of the current definition (a permanent gluten sensitive enteropathy), clinical, pathological, epidemiological, and immunological approaches are reveal-ing several forms of coeliac disease. In so called active coeliac disease, malabsorption, and nutritional deficiencies range from profound to minimal; clinically silent coeliac disease is being increasingly recognised-for example, in family studies. Pathologically there is also a degree of heterogeneity. Descriptive terms such as' flat mucosa', or'subtotal villus atrophy', are the pathologist's shorthand for a cluster of features (villus, crypt sizes, epithelial cell damage, intra-epithelial and lamina propria lymphoid cell infiltrates) which together characterise the enteropathy of coeliac disease. Quantitative histology and computerised image analysis have shown that these features occur in a continuum, with the flat lesion at one end of the spectrum and a mucosa with normal villus and crypt architecture, but an abnormally high density or count of villus intraepithelial lymphocytes, at the other. 2 The latter would be reported as normal by most clinical pathologists. This fact is important when the evidence for the existence of latent coeliac disease is reviewed. This term should only be applied to patients who fulfil the following conditions:(i) have a normal jejunal biopsy while taking a normal diet;(ii) at some other time, before or since, have had a flat jejunal biopsy which recovers on a gluten free diet.The suggestion that there might be a'precoeliac'state was first made by Weinstein who described two patients with dermatitis herpetiformis and normal jejunal biopsies in whom typical coeliac like enteropathy developed some weeks after 20 g gluten was added to their already gluten containing diet. 3 Two studies from the United Kingdom have con-firmed this observation45 and the concept is supported by case reports of coeliac patients in whom, by chance, a jejunal biopsy has previously been taken and reported as normal." 8