根據(jù)一項(xiàng)發(fā)表在2012年8月那期American Journal of Hematology期刊上的研究,，患有乳糜瀉(celiac disease)的病人,，特別是那些在生命后期患上吸收不良癥(malabsorption symptom)那些病人，有更高的淋巴增生性疾病(lymphoproliferative disorder, LPD)發(fā)生率,。
來(lái)自美國(guó)哥倫比亞大學(xué)醫(yī)學(xué)中心的Lori A. Leslie博士和同事們開(kāi)展一項(xiàng)涉及1285名患有乳糜瀉的成年人的回顧性群體研究以便確定LPD亞型發(fā)生率和不同LPD亞型的存活時(shí)間,。
研究人員鑒定出40名病人患上LPD(標(biāo)準(zhǔn)化發(fā)病比[standardized incidence ratio, SIR]為6.48)，其中33名患上非何杰金淋巴瘤(non-Hodgkin's lymphoma, NHL; SIR為6.91),。當(dāng)患上LPD之前,，只考慮確診為乳糜瀉的那些病人時(shí)，腸病相關(guān)性T細(xì)胞(enteropathy-associated T-cell, EATL),、非EATL T細(xì)胞(non-EATL T-cell),、彌漫性大B細(xì)胞(diffuse large B-cell)、套細(xì)胞(mantle cell)和邊緣區(qū)(marginal zone)非何杰金淋巴瘤亞型發(fā)生率與乳糜瀉的關(guān)聯(lián)性顯著提高,。
相對(duì)于患上非EATL的病人,，患上 EATL的病人平均存活時(shí)間更短?；忌螸PD的病人更可能發(fā)生腹瀉,、腹痛和/或體重減輕，而且被真多為乳糜瀉的時(shí)間更晚(由41.4歲上升至57.9歲),。
研究人員寫道,，“在未來(lái)，我們還需進(jìn)一步分析乳糜瀉和不同LPD亞型之間的關(guān)聯(lián)性以便鑒定出炎癥途徑和淋巴增殖途徑中的相同分子,，并將它們作為大有希望的靶標(biāo)以便用于藥物開(kāi)發(fā),。這些發(fā)現(xiàn)可能被用來(lái)對(duì)病人患上淋巴瘤的風(fēng)險(xiǎn)進(jìn)行分類，設(shè)計(jì)監(jiān)測(cè)方案,，并給有更高風(fēng)險(xiǎn)患上LPD的乳糜瀉病人提出預(yù)防性策略,。”(生物谷：Bioon.com)
本文編譯自Celiac disease linked to lymphoproliferative disorders
doi: 10.1002/ajh.23237
PMC:
PMID:
Incidence of lymphoproliferative disorders in patients with celiac disease
Lori A. Leslie1, Benjamin Lebwohl2, Alfred I. Neugut3,4, John Gregory Mears3, Govind Bhagat5, Peter H.R. Green
Prior studies describe an increased incidence of lymphoma in celiac disease. However, few studies differentiate among lymphoproliferative disorders (LPDs). Our aim was to determine incidences of LPD subtypes in celiac disease patients, describe patterns of celiac disease presentation in patients who develop LPD, and compare survival in patients with various LPD subtypes. We conducted a retrospective cohort study of adults with biopsy-proven celiac disease seen at a US referral center from 1981 to 2010, identified patients with comorbid LPD, and calculated standardized incidence ratios (SIR) for each LPD subtype. In our cohort of 1,285 patients with celiac disease, there were 40 patients with LPD [SIR = 6.48, 95% confidence interval (CI) = 4.62–8.64] including 33 with non-Hodgkin lymphoma (NHL, SIR = 6.91, 95% CI = 4.26–8.28). The incidences of NHL subtypes including enteropathy-associated T-cell (EATL, n = 12), non-EATL T-cell (SIR = 22.43, 95% CI = 7.08–46.41), diffuse large B-cell (SIR = 5.37, 95% CI = 1.93–10.52), mantle cell (SIR = 32.21, 95% CI = 6.07–78.97), and marginal zone (SIR = 37.17, 11.73–76.89) lymphoma remained significantly elevated when only those diagnosed with celiac before LPD were considered (n = 24, NHL SIR = 4.47, 95% CI = 2.86–6.44). Patients who developed LPD were older at time of celiac disease diagnosis (57.9 ± 15.5 versus 42.5 ± 17.4 years, P < 0.0001) and more likely to present with diarrhea (60.0% versus 39.8% P = 0.016), abdominal pain (17.5% versus 5.5% P = 0.0046), and/or weight loss (12.5% versus 4.0%, P = 0.028). EATL patients had a shorter average survival than non-EATL NHL patients (3.2 versus 15.0 years, P = 0.016). The incidence of LPD is increased in celiac disease patients. Those diagnosed later in life who present with symptoms of malabsorption are more likely to be diagnosed with LPD.
