Активность кишечных карбогидраз у больных целиакией в зависимости от приверженности аглютеновой диете

Abstract

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.