■乳糜泻(CD)与各种病因的门脉高压(PHT)有关,但是因果关系从未被证明。我们旨在研究不同病因的PHT患者中CD的患病率。
■2017年6月至2018年12月进行了一项前瞻性观察性研究,涉及所有不同病因的PHT病例。慢性肝病(CLD)明确病因如乙醇的PHT连续患者,病毒性肝炎(B或C),布加综合征(BCS),自身免疫性肝硬化,和隐源性CLD(cCLD)(A组)和非肝硬化PHT(NCPHT),其中包括非肝硬化门静脉纤维化(NCPF)和肝外门静脉阻塞(EHPVO)(B组),在血清学阳性患者中,通过IgA抗tTG抗体筛查CD,然后进行十二指肠活检。
■在总共464名患者中,A组共382名患者,与乙醇相关的CLD(155),cCLD(147),乙型肝炎(42),丙型肝炎(21),自身免疫性(10),和BCS(7),而B组82例患者有NCPF(64)和EHPVO(18)。两组共29例确诊为CD,A组17例(4.5%),B组12例(14.6%)。在A组中,13例cCLD患者,两个与HBV相关的CLD,一个有BCS,1例与自身免疫相关的CLD同时被诊断为CD。B组,在12例NCPF(11)和EHPVO(1)患者中诊断为CD。肝组织学检查显示2例慢性肝炎,3例正常。
■CD在不同病因的PHT中很常见,尤其是在cCLD中,NCPH和自身免疫性肝炎;然而,这种关联的病因学基础仍有待确定.肝病患者发生CD的可能性高于一般人群,这些患者应该进行CD筛查。
UNASSIGNED: Celiac disease (CD) has been linked to portal hypertension (PHT) of varied etiology, but the causality association has never been proved. We aim to study the prevalence of CD in patients of PHT of different etiology.
UNASSIGNED: A prospective observational study was conducted from June 2017 to December 2018 involving all the cases of PHT of varied etiology. Consecutive patients of PHT with chronic liver disease (CLD) of defined etiology like ethanol, viral hepatitis (B or C), Budd-Chiari syndrome (BCS), autoimmune-related cirrhosis, and cryptogenic CLD (cCLD) (group A) and those with noncirrhotic PHT (NCPHT), which included noncirrhotic portal fibrosis (NCPF) and extrahepatic portal vein obstruction (EHPVO) (group B), were screened for CD by IgA anti-tTG antibody followed by duodenal biopsy in serology-positive patients.
UNASSIGNED: Out of a total of 464 patients, group A constituted 382 patients, CLD related to ethanol (155), cCLD (147), hepatitis B (42), hepatitis C (21), autoimmune (10), and BCS (7), whereas 82 patients were in group B with NCPF (64) and EHPVO (18). Total 29 patients were diagnosed with CD in both groups, 17 in group A (4.5%) and 12 in group B (14.6%). In group A, 13 patients with cCLD, two with HBV-related CLD, one with BCS, and one with autoimmune-related CLD were concomitantly diagnosed as CD. In group B, CD was diagnosed in 12 patients of NCPF (11) and EHPVO (1). Liver histology showed chronic hepatitis in two patients and was normal in three patients.
UNASSIGNED: CD is common in PHT of different etiology, especially in cCLD, NCPH and autoimmune hepatitis; however, the etiological basis for this association is still to be defined. The likelihood of CD is higher in liver disease than the general population, and these patients should be screened for CD.