乳糜泻患者肠道碳水化合物酶活性与坚持无麸质饮食的关系

S. Bykova, E. Sabelnikova, O. Akhmadullina, A. Novikov, N. Belostotsky, E. Baulo, S. Dbar, A. Parfenov
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引用次数: 0

摘要

乳糜泻是一种典型的自身免疫性疾病,在基因决定的个体中,由于对含麸质食物的反应,会引发肠细胞损伤和小肠黏膜绒毛萎缩。上皮细胞膜超微结构的破坏导致消化运输通道的破坏,从而破坏消化运输通道中最重要的阶段——膜消化,而膜消化在营养物质的最终同化中起着重要的作用。肠道糖酶活性与黏膜绒毛萎缩程度存在相关性,提示双糖酶活性可作为乳糜泻TTS功能恢复的指标。目的:评估腹腔疾病患者肠道糖酶的活性,这取决于对GFD的依从性。材料和方法。我们检查了109例乳糜泻患者,诊断标准是临床症状、血清学检查和组织学资料的结合。患者年龄中位数为41.5岁(Q1-Q3: 30-55岁,Shapiro p值< 0.01)。男性16例(14.7%),中位年龄30岁;女性:93例(85.3%),中位年龄44岁。根据对GFD的坚持,乳糜泻患者被分为3组:I组- 39例新诊断的乳糜泻患者,II组- 28例有意识或无意识违反GFD的患者,III组- 42例从6个月到15年观察到GFD的患者。对照组由30名年龄和性别相当的实际健康的人组成。平均年龄33.9岁(第一季至第三季:24-35岁)。所有患者均行食管胃十二指肠镜检查,对粘膜组织进行形态学和生化研究,并根据N.I. Belostotsky修改的a . Dalkvist方法研究肠道糖酶活性。小肠黏膜双糖酶活性以每毫克组织每分钟的纳克葡萄糖(ng葡萄糖/mg组织× min)表示。结果。在新诊断的乳糜泻患者中,与III组相比,葡萄糖淀粉酶(84.6%)、麦芽糖酶(87.2%)和蔗糖酶(82.05%)的活性下降(p < 0.01)更为常见(葡萄糖淀粉酶- 33.3%;Maltase - 45.2%;蔗糖- 45.2%)。61.5%的患者缺乏糖酶(葡萄糖淀粉酶、麦芽糖酶、蔗糖酶和乳糖酶)。对比我们所检查的患者组中糖酶活性指标,发现随着AGD的出现,葡萄糖淀粉酶、蔗糖酶和麦芽糖酶的平均活性水平明显升高,但其平均值仍低于对照水平,与麦芽糖酶的相关性较小。因此,在III组中,麦芽糖酶水平为860 (644.5;1413.5),对照组为887.0 (854.5;1146),这表明麦芽糖酶在严格遵守GFD的情况下具有很高的恢复能力。不同坚持GFD患者的研究组乳糖活性水平无显著差异,且明显低于对照组,说明患者存在乳糖酶缺乏,难以通过GFD纠正。结论。综上所述,严格AHD的乳糜泻患者可以通过研究小肠糖酶的活性来评估黏膜功能恢复的程度。
本文章由计算机程序翻译,如有差异,请以英文原文为准。
The Activity of Intestinal Carbohydrases in Patients with Celiac Disease, Depending on Adherence to the Gluten-free Diet
Celiac disease is a classic autoimmune disease that triggers enterocyte damage and villous atrophy of the small intestine mucosa in genetically determined individuals in response to gluten-containing foods. Damage to the ultrastructure of epithelial cell membranes causes breakdown of the digestive transport conveyor, which disrupts the most important stage of the digestive transport conveyor – membrane digestion, which plays an important role in the final assimilation of nutrients. There is evidence of a correlation between the activity of intestinal carbohydrases and the degree of atrophy of the mucosa villi, which suggests that the activity of disaccharidases can serve as an indicator of the functional recovery of TTS in celiac disease. Objective: to assess the activity of intestinal carbohydrases in patients with celiac disease, depending on adherence to GFD. Materials and methods. We examined 109 patients with celiac disease, the diagnostic criterion for which was a combination of clinical symptoms, serological tests and histological data. The median age of the examined patients was 41.5 years (Q1–Q3: 30–55 years, Shapiro p-value < 0.01). There were 16 men (14.7%), median age 30; women – 93 (85.3%), median age 44 years. Depending on adherence to GFD, patients with celiac disease were divided into 3 groups: Group I – 39 patients with newly diagnosed celiac disease, Group II – 28 patients who consciously or unconsciously violated GFD, Group III – 42 patients who observed GFD from 6 months up to 15 years. The control group consisted of 30 practically healthy people comparable in age and sex. Their average age was 33.9 years (Q1–Q3: 24–35). All patients underwent esophagogastroduodenoscopy with a morphological and biochemical study of the mucosal tissue with a study of the activity of intestinal carbohydrases according to the method of A. Dalkvist modified by N.I. Belostotsky. The activity of disaccharidases of the small intestine mucosa was expressed in nanograms of glucose per milligram of tissue per minute (ng glucose/mg tissue × min). Results. In patients with newly diagnosed celiac disease, a decrease in the activity of glucoamylase glucoamylase (84.6%), maltase (87.2%) and sucrase (82.05%) (p < 0.01) is significantly more often detected compared to group III (glucoamylase – 33.3%; maltase – 45.2%; sucrase – 45.2%). Deficiency of all carbohydrases (glucoamylase, maltase, sucrase and lactase) was detected in 61.5% of patients. When comparing the indicators of carbohydrase activity in the groups of patients examined by us, it turned out that the average level of activity of glucoamylase, sucrase and maltase increased significantly more often as AGD was observed, however, their average values remained below the control level, which was less related to maltase. Thus, in group III, the level of maltase was 860 (644.5; 1413.5), and in the control group – 887.0 (854.5; 1146), which indicates a high ability of maltase to recover with strict adherence to GFD. The level of lactose activity in the studied groups of patients with different adherence to GFD did not differ significantly and was significantly lower than that in the control group, which indicates the presence of lactase deficiency in patients, which is difficult to correct by GFD. Conclusion. Based on the results of the work, it can be concluded that patients with celiac disease observing strict AHD are shown to study the activity of small intestine carbohydrases to assess the degree of recovery of the functional capabilities of the mucosa.
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