乳糜泻13例诊治分析

Diagnosis and treatment of 13 celiac disease patients

目的探讨乳糜泻患者的临床特点,提高对该疾病的诊疗水平.方法回顾性分析2004年1月~2017年12月于我院住院的13例乳糜泻患者的临床资料.结果13例患者中,男10例,女3例,平均发病年龄(43.9±18.0)岁.所有患者均以慢性腹泻起病,腹泻频率为每日(10±4)次,腹泻量为(1428±731)ml/d,10例患者表现为水样便.起病后患者体重平均下降(13.7±7.4)kg.乳糜泻患者营养状况较差,其中9例伴血清铁或铁蛋白降低,3例伴维生素D缺乏.所有患者均接受内镜检查,内镜下见小肠黏膜粗糙不平、呈粗颗粒样改变者5例(38.5%),小肠黏膜活检病理结果提示十二指肠绒毛缩短或萎缩者13例(100.0%),固有层较多浆细胞及淋巴细胞浸润者10例(77.0%),10例(77.0%)符合Marsh 3级.开始无麸质饮食(GFD)后,11例患者(84.6%)腹泻症状迅速缓解,1例对于GFD反应较差的患者活检病理结果提示为黏膜相关淋巴组织淋巴瘤,另1例后期随访中发展为肠病相关T细胞淋巴瘤.结论乳糜泻导致的小肠吸收不良可表现为渗透性腹泻及脂肪泻.我院收治的乳糜泻患者平均年龄较大,病程长,症状严重,长期未治疗的乳糜泻发展为淋巴瘤的风险较高,而淋巴瘤可能引起腹泻性质的变化,需引起注意.

Objective To analyze the clinic al features of 13 celiac disease patients in order to improve the diagnosis and treatment of this disease.Methods Clinical data of 13 celiac disease patients admitted to our hospital from January 2004 to December 2017 were analyzed retrospectively.Results Of the 13 patients,10 were male and 3 were female.The average age of disease onset was(43.9±18.0)years old.All patients presented as chronic diarrhea during disease onset.The average number of bowel movements was(10±4)times per day,while the stool volume was(1428±731)ml/d.Ten patients showed watery diarrhea.The average weight loss after disease onset was(13.7±7.4)kg.The nutritional status of celiac disease patients was poor,including 9 cases of iron deficiency and 3 cases of vitamin D deficiency.All 13 patients underwent endoscopy exami nation,revealing rough and coarse-grained change in the duodenum mucosa in 5 patients(38.5%).Mucosal biopsy showed shortening or atrophy of duodenal villi in 13 patients(100.0%),plasma cell and lymphocyte infiltration in the lamina propria among 10 patients(77.0%).Ten cases(77.0%)were graded Marsh 3.After starting a gluten-free diet(GFD),11 patients(84.6%)had rapid relief of diarrheal symptoms.One patient that had poor response to GFD was diagnosed mucosa-associated lymphoid tissue lymphoma through biopsy.And another patients developed enteropathy-associated T-cell lymphoma during follow-up.Conclusion Intestinal malabsorption caused by celiac disease can manifest as osmotic diarrhea and steatorrhea.The celiac patients admitted to our hospital were old in age,and had long disease durations and serious symptoms.Untreated celiac disease have higher risks of developing lymphoproliferative disorders.Awareness of such complications is needed.