小结
定义
病史和体格检查
关键诊断因素
- 免疫球蛋白 (IgA) 缺乏症
- 腹泻
- 腹胀
- 腹痛/腹部不适
- 贫血
- 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
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
- 干燥综合征
- 炎症性肠病
- 原发性胆汁性胆管炎
诊断性检查
首要检查
- 全血细胞计数和血涂片
- 抗组织转谷氨酰胺酶 IgA 抗体 (IgA-tTG)
- 肌内膜抗体 (EMA)
- 皮肤活检
- 去酰胺醇溶蛋白肽 (DGP) IgG 或者 DGP IgA/IgG
- IgG-tTG
- 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
Clinical Research Fellow in Celiac Disease
Harvard Medical School
Beth Israel Deaconess Medical Center
Boston
MA
利益声明
AT declares that she has no competing interests.
Ciaran P. Kelly, MD
Professor of Medicine
Harvard Medical School
Beth Israel Deaconess Medical Center
Boston
MA
利益声明
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.
鸣谢
Dr Amelie Therrien and Professor Ciaran P. Kelly would like to gratefully acknowledge Dr Daniel A. Leffler, a previous contributor to this topic.
利益声明
DAL declares that he has no competing interests.
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
- 儿科乳糜泻诊断指南
- 乳糜泻诊断和监测的临床实践更新——血清学检查和组织学指标的效用变化：专家评审
更多 指南患者教育信息
Coeliac disease
更多 患者教育信息
登录或订阅即可浏览 BMJ Best Practice 临床实践完整内容
内容使用需遵循免责声明