小结
定义
病史和体格检查
关键诊断因素
- 腹泻
- 腹胀
- 腹痛/腹部不适
- 贫血
- 免疫球蛋白 (IgA) 缺乏症
- 疱疹样皮炎
其他诊断因素
- 家族史
- 骨质减少/骨质疏松症
- 疲劳
- 体重减轻
- 生长迟缓
- 1 型糖尿病
- 自身免疫性甲状腺病
- 口疮性口炎
- 牙轴质发育不全
- 容易出现瘀伤
- 周围神经病
- 共济失调
- 不明原因的血清转氨酶水平升高
- 合并精神病的诊断
危险因素
- 乳糜泻家族史
- 免疫球蛋白 A 缺乏症
- 1 型糖尿病
- 自身免疫性甲状腺病
- 唐氏综合征
- Turner 综合征
- 干燥综合征
- 炎症性肠病
- 原发性胆汁性胆管炎
- 银屑病
诊断性检查
首要检查
- 抗组织转谷氨酰胺酶 IgA 抗体 (IgA-tTG)
- IgA 定量检测
- IgG DGP（脱酰胺醇溶蛋白肽）
- 全血细胞计数 (FBC）
- 肌内膜抗体 (EMA)
- 皮肤活检
- 小肠镜检查
- 小肠组织学检查
需考虑的检查
- 人类白细胞抗原 (HLA) 分型
- 麸质激发试验
- 电视胶囊内镜检查
治疗流程
乳糜泻
对治疗无反应/难治性乳糜泻
乳糜泻危象
撰稿人
作者
Amelie Therrien, MD
Gastroenterologist, Celiac Center
Instructor in Medicine, Harvard Medical School
Beth Israel Deaconess Medical Center
Boston
MA
利益声明
AT is a site principal investigator for National Institute of Allergy and Infectious Diseases NIAID (IMX003 [latiglutenase]).
Benjamin Lebwohl, MD, MS
Associate Professor of Medicine and Epidemiology
Columbia University Irving Medical Center
New York
NY
利益声明
BL is an unpaid advisor for Nima Partners, Takeda, Teva, 9 Meters Biopharma, Bristol Myers Squibb, Mozart Therapeutics, and Alimentiv and a contractual researcher for Anokion. BL is an author of several references in this topic.
鸣谢
Dr Amelie Therrien and Dr Benjamin Lebwohl would like to gratefully acknowledge Professor Ciaran P. Kelly and Dr Daniel A. Leffler, previous contributors to this topic.
利益声明
DAL declares that he has no competing interests. CPK is a scientific advisor/consultant for Cour Pharma, Glutenostics, Immunogenx, Innovate, and Takeda Pharmaceuticals. He is an investigator for Aptalis and Takeda, and has stock options in Cour Pharma and Glutenostics. CPK is also a co-author of several references cited in this topic.
同行评议者
Matthew Kurien, PGDip MedSci, MD, MBChB, MRCP
Senior Clinical Lecturer and Honorary Consultant Gastroenterologist
Department of Infection, Immunity & Cardiovascular Disease
Sheffield Medical School
Sheffield
UK
利益声明
MK declares that he has no competing interests.
Eli D. Ehrenpreis, MD
Professor of Medicine
Rosalind Franklin Medical School
Chicago
IL
利益声明
EDE declares that he has no competing interests.
鉴别诊断
- 消化性十二指肠炎
- 克罗恩病
- 贾第鞭毛虫病
更多 鉴别诊断指南
- 乳糜泻的诊断和管理
- 消化道内镜操作的知情同意
更多 指南患者教育信息
乳糜泻
更多 患者教育信息
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