Çölyak hastalığı; 5 yıllık takip, antikor-patoloji korelasyonu

Yıl 2016, Cilt: 24 Sayı: 2, 43 - 46, 31.08.2016

Nurettin Tunç Abdurahman Şahin , Sibel Orhan Mehmet Yalnız Ulvi Demirel , Orhan Kürşat Poyrazoğlu İbrahim Halil Bahçecioğlu

https://doi.org/10.17940/endoskopi.328622

Öz

Giriş ve Amaç: Bu çalışmanın amacı çölyak hastalığı tanısı ile takip edilen

hastaların klinik, laboratuvar ve patolojik özelliklerinin araştırılmasıdır. Gereç

ve Yöntem: Kliniğimizde çölyak hastalığı tanısı ile takip edilen hastalar

retrospektif olarak değerlendirildi. Anti-gliadin antikor immunglobulin A,

anti-endomisyum, doku transglutaminaz immunglobulin A ve immunglobulin

G antikorları kaydedildi. Hastaların tanı anında klinik ve laboratuvar

özellikleri patolojik Marsh sınıflamasına göre gruplara ayrılarak gruplar arası

farklılıklar saptanmaya çalışıldı. Bulgular: Çalışmaya kliniğimizde takip edilen

toplam 174 hasta alındı. Hastaların 107’si (%61,5) kadın, 67’si (%38,5)

erkekti. Ortalama tanı yaşı 30,67 (min/mak:18/73)’tü. Tanı anında hastaların

%24’ünde anemi, 118 hastanın 24’ünde (%20,3) vitamin B12 eksikliği, 110

hastanın 27’sinde (%24,5) folik asit eksikliği mevcuttu. D vitamini eksikliği

84 hastanın 63’ünde (%75) saptandı. Kemik mineral dansitometresi bakılan

53 hastanın %49,1’inde (26/53) osteoporoz, %41,5’inde osteopeni (22/53)

saptandı ve %9,4’ü normaldi. Endoskopik biyopsi sonuçları Marsh sınıflamasına

göre; 17’si (%14) sınıf 1, 20’si (%16,5) sınıf 2, 71’i (%58,6) sınıf 3 ve

13’ü (%10,7) sınıf 4 grubundaydı. Marsh 1’de sırasıyla anti-gliadin antikor

immunglobulin A, anti-endomisyum, doku transglutaminaz immunglobulin

A, doku transglutaminaz immunglobulin G pozitiflik oranları %22.2, %50,

%54.5 ve %20 iken Marsh 4’te pozitiflik oranları sırası ile %100, %100,

%81.8 ve %87’ye çıkmaktadır. Antikor pozitifliğinin Marsh 1’den Marsh 4’e

giderek arttığı gözlendi. Sonuç: Marsh 1 hastalarında düşük oranda antikor

pozitifliği saptanması bu grup hastaların bir kısmının çölyak olmayabileceğini

düşündürmektedir. Marsh 1 saptanan olguların kesin çölyak hastalığı

tanısı öncesi, diğer hastalıklar yönünden irdelenmesi gerekmektedir.

Anahtar Kelimeler

Çölyak hastalığı, Marsh skoru

Celiac disease: 5-year follow-up antibody-pathology correlation

Öz

Background and Aims: The aim of this study is to investigate the clinical,

laboratory, and pathological findings of patients who were clinically diagnosed

and followed with celiac disease. Materials and Methods: Patients

with a diagnosis of celiac disease who were followed in our center were evaluated

retrospectively. Anti-gliadin immunoglobuline A, anti-endomysium,

and tissue transglutaminase immunoglobuline A and immunoglobuline G

antibodies were recorded. Clinical and laboratory characteristics of patients

at the time of diagnosis of celiac disease were studied to determine the differences

between groups according to the Marsh pathological classification. Results:

A total of 174 patients with celiac disease who were followed in-clinic

were recruited into the current study. One-hundred and seven patients

(61.5%) were female, and 67 (38.5%) were male. The mean age at the time of

diagnosis was 30.67 (min/max: 18/73). Twenty-four percent of patients had

anemia at the time of diagnosis. Vitamin B12 deficiency was found in 24 of

118 patients (20.3%). Folic acid deficiency was found in 27 of 110 patients

(24.5%). Vitamin D deficiency was found in 63 of 84 (75%) patients. Bone

mineral density measurements were available for 53 patients; 26 patients

(49.1%) had osteoporosis, 22 patients (41.5%) had osteopenia, and 9.4%

of patients had normal bone mineral densities. Endoscopic biopsy results

according to Marsh classification were as follows: 17 patients (14%) were

in class 1, 20 patients (16.5%) were in class 2, 71 (58.6%) were in class 3

and 13 (10.7%) were in class 4. While Marsh 1 Anti-gliadin immunoglobuline

A, anti-endomysium, tissue transglutaminase immunoglobuline A, and

tissue transglutaminase immunoglobuline G positivity rates were 22.2%,

50%, 54.5%, and 20%, respectively, in the Marsh 1 group, positivity rates

were increased to 100%, 100%, 81.8%, and 87%, respectively in the Marsh

4 group. Antibody positivity increased gradually from Marsh 1 to Marsh 4.

Conclusion: Lower rates of antibody positivity in patients with Marsh class

1 suggest that this group of patients might be misdiagnosed with Celiac disease.

Celiac disease must be confirmed strictly in Marsh class I patients. This

group of patients must be examined closely before a definite diagnosis of

celiac disease is made.

Anahtar Kelimeler

Celiac disease, Marsh score, correlation of antibody

Kaynakça

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