Résumé
Objective To summarize the clinical features of different racial patients with celiac disease (CD) and analyze the disease prevalence,diagnosis and treatment in Chinese population.Methods All the patients were diagnosed as CD and enrolled in Beijing United Family Hospital between January 2005 and July 2015.Clinical data including nationality,age,symptoms,endoscopic and pathological findings,outcome were collected and compared in patients from different countries.Results A total of 87 patients were enrolled including 63 Caucasians,18 Asian patients and 6 Middle East patients.The peak age of disease onset was 40-60 years old.Patients with typical symptoms such as chronic diarrhea and weight loss only accounted for 20.7％ (18/87) and 9.2％ (8/87) respectively.Some patients presented with nonspecific symptoms such as abdominal pain and bloating [32.2％ (28/87)],even constipation [5.7％ (5/87)].13.8％ (12/87) patients were previously diagnosed as irritable bowel syndrome.The incidence of abdominal pain,bloating,diarrhea and constipation between Asians and Caucasians had no statistical significance (P ＞ 0.05);but the proportions of weight loss,growth retardation,iron deficiency anemia and dermatitis herpetiformis in Asian group were significantly higher than that in Caucasian group (P ＜ 0.05).IgA type of anti-gliadin antibody (AGA),endomysium antibody (EMA) and tissue transglutaminase antibody (tTGA) were dominant autoimmune antibodies in patients with CD,which accounted for 58.6％ (51/87),44.8％ (39/87) and 36.8％ (32/87) respectively.The endoscopy showed that the lesion of CD was mainly located in small intestine,with reducing severity from the proximal to the distal small intestine.The lesions of duodenal bulb and descending duodenum appeared more significant in Asian group.Accordingly pathological intestinal atrophy and the degree of intraepithelial lymphocytosis were more severe in Asian patients.All 87 cases took the gluten-free diet (GFD).Eighty-one cases received serological follow up and 8 with endoscopic intestinal biopsy.The celiac disease antibodies in 47 patients turned negative from 6-9 months after GFD treatment,while 34 patients turned negative from 12-18 months after GFD.All patients reported disease remission to some extent.After 1 year GFD treatment,the pathology of endoscopic intestinal biopsy in 8 patients showed significant improvement of villous atrophy and lymphocyte infiltration.Conclusions CD patients with typical clinical manifestations are not the majority.Serological celiac disease antibodies (AGA,EMA and tTGA) have a high diagnostic value.GFD treatment is effective on majority of celiac patients.Clinical manifestations,endoscopy,intestinal pathology,and response to GFD in Chinese patients are not the same as Caucasians.Clinicians need to pay attention to the differential diagnosis.
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Objective To evaluate the international blood smear review criteria for improvement using Beckman-Coulter hematology analyzers and find out proper slide review criteria suitable for Chinese population. Methods 3 600 random-selected blood samples were tested in three hospitals using MAXM, GENS and LH750 5-diff automated analyzers and a manual differential with a smear review was performed on all samples in the study. True positive rate, true negative rate, false positive rate and false negative rate were calculated according to the international blood smear review criteria. We have set up smear review criteria for Chinese population by analyzing false positive and false negative cases according to Chinese clinical conditions. Another 240 blood samples were tested in three hospitals using the same analyzers to verify the new slide review rules. Results According to international blood smear criteria, the true positive rate was 4.9%, false positive rate was 24.2%, true negative rate was 70.4% and false negative rate was 0.5%. The international smear review criteria were modified into 23 criteria by analysis of above statistical data. In addition, we added four WBC differential ratio rules in positive smear criteria. After modification, the true positive rate was 9.9% (355/3 600) ,false positive rate was 17.1% (617/3 600), true negative rate was 71.2 % (2 563/3 600) and false negative rate was 1.8% (65/3 600). No blast cell was missed using both smear review criteria. A little higher false negative rate after modification was caused by supplemented differential ratio roles in positive smear criteria. Verification results were satisfactory;The tree positive rate was 13.7% (33/240) ;false positive rate was 15.8% (38/240) ;false negative rate was 2.5% (6/240) and true negative rate was 68.0% (163/240). Conclusions Although the smear review criteria suggested by the International Consensus Group is clinically important, the false positive rate increases when they are used in Chinese population. The modified slide review criteria used on Beckman-Coulter hematology analyzers in this study are more suitable for Chinese laboratories.
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Objective To find a proper way for accurate results on complete blood counts.Methods Based on the results from automatic hematology analyzer, set up criteria for blood cell microscopic examination. 9 992 blood specimens were detected and the results were analyzed according to the criteria, statistics on the data were made to find out the reliability of the policy.Results The criteria could help to find more abnormal cells, it was very useful for clinical diagnosis and proper treatment.There were 29.3% of CBC specimens needed for microscopic examination, 32.2% of which had increased bands or increased atypical lymphocytes or other abnormalities.Conclusions It was very important to set up the criteria for performing peripheral blood smear. It can provide more accurate and reliable information to clinical doctors.