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原创 不明原因消瘦?可能是乳糜泻(Celiac disease

练磊 主任医师 中山六院 胃肠肛门外科
2016-03-15 842人已读
练磊 主任医师
中山六院

Celiac disease (CD) is a common digestive disease in persons of European descent. It is also known as celiac sprue, gluten-sensitive enteropathy, or nontropical sprue. In individuals with CD, gluten (a protein in wheat, barley, and rye) damages the small intestine and results in difficulty absorbing nutrients from food. Up to 1 in 113 people in the United States have CD. The risk is higher (1 in 22) in people with a first-degree relative with CD. The cause of CD is unknown, but environmental, immunologic, and genetic factors all contribute.中山大学附属第六医院胃肠肛门外科练磊

乳糜泻(CD,又译谷胶病、麸质过敏症等)是欧洲后裔人群常见的消化道疾病。也称为麸质腹泻、麸质过敏性肠病,或非热带腹泻。在CD患者中,麸质(小麦、大麦、黑麦等中含有的蛋白质)破坏小肠,造成营养吸收困难。在美国,大约每113个人中就有一个患有CD。如果一级亲属患有CD,患病风险更高(每22人中有一个)。CD的病因不明,但可能与环境、免疫、基因等因素都有关联。

CAUSE AND PATHOLOGY

病因及病理

It is believed that there is an immunologic (having to do with the immune system) aspect to CD. Several autoantibodies (antibodies are normal parts of the body that fight against something trying to invade it; autoantibodies are abnormally directed against one's own body) are found in the blood in patients with CD. It is not certain whether these autoantibodies are a cause of CD or a result of damage from it. There is also a genetic component to CD. Almost all patients have a particular gene, but only a small number of people with that gene have CD. When people with CD eat foods or use products containing gluten, the immune system responds by damaging or destroying villi (tiny fingerlike protrusions lining the small intestine). Nutrients from food are absorbed through the small intestine walls into the bloodstream. Villi increase the amount of surface space in the small intestine for absorption of nutrients. Without healthy villi, people become malnourished no matter what they eat.

CD与免疫系统有关。CD患者血液中可以找到几种自身抗体(抗体是机体抵抗外部致病因素的人体正常现象,自身抗体是不正常的,对抗的是自身组织)。CD也有遗传因素。几乎所有的患者都有某一个特定基因,但是只有少数基因携带者出现CD。当CD患者进食或使用含有麸质的食物,机体的免疫系统就会起反应,破坏绒毛(小肠内面纤指状的突起)。食物中的营养都是经过小肠的肠壁吸收进入血液的。绒毛可以增加小肠的吸收面积。没有了健康的绒毛,无论吃什么患者都会出现营养不良。


SYMPTOMS
症状

Symptoms of CD include abdominal bloating or pain; chronic diarrhea; vomiting; constipation; pale, foul-smelling, or fatty stools; and weight loss. Adults may not have as many of these symptoms as children. Rather, adults with CD are more likely to have unexplained anemia (low red blood count), fatigue, bone or joint pain, arthritis, bone loss or osteoporosis, depression or anxiety, tingling numbness in the hands and feet, or an itchy rash known as dermatitis herpetiformis.

CD 的症状包括腹胀、腹痛、慢性腹泻、呕吐、便秘、苍白,粪便恶臭或油状,以及体重下降。与儿童不一样,成年人可能不一定都出现这些症状。成年人CD更容易出现贫血(血液红细胞计数下降)、乏力、骨关节疼痛、关节炎、骨质丢失或骨质疏松抑郁或焦虑、手脚刺痛麻木感,或皮肤瘙痒皮疹即疱疹痒皮炎。
DIAGNOSIS AND TREATMENT
诊断及治疗

Small-intestinal biopsy showing abnormal villi is considered the best way to diagnose CD. Many cases of CD are never diagnosed.

小肠活检显示绒毛异常是CD的最佳诊断方法。许多CD患者没有得到诊断。

The only treatment for patients with CD is avoiding foods containing or made from wheat, barley, and rye for the rest of their lives. Eating even a small amount of gluten can damage the small intestine. In children, the small intestine usually heals within 3 to 6 months, but it may take years to heal in adults. Oats are safe in small amounts, although oats are often processed in facilities that also process other grains. Rice, potato, soy, and buckwheat are safe to eat. It is important for people with CD to read product labels, as gluten is used as an additive in some medications, lipstick, vitamins, and even Play-Doh.

CD的唯一治疗方法就是终生避免进食含有小麦、大麦或黑麦等的食品。即使只进食少量的麸质也会破坏小肠。在儿童,小肠在3-6个月内可以得到修复,但成人可能需要几年的时间来恢复。少量的燕麦是安全的,但处理燕麦的设备常常同时也处理谷类。大米、马铃薯、大豆以及荞麦等都是安全的。CD患者应该学会阅读食品的标签,这非常重要,因为麸质常常被用来作为药物、唇膏、维生素等,甚至是培乐多泥胶。

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