原標(biāo)題：食物特異性 IgG4 抗體引導(dǎo)的排除飲食可改善慢性疼痛患者的狀況
序言：慢性疼痛與胃腸道（GI）功能有關(guān)，因?yàn)槭澄锍煞滞ㄟ^對胃腸道免疫和/或神經(jīng)系統(tǒng)的作用來影響炎癥和疼痛，而且許多鎮(zhèn)痛藥與腸道相互作用，改變其結(jié)構(gòu)和功能。免疫球蛋白G4 (IgG4)是腸道免疫系統(tǒng)暴露于營養(yǎng)物質(zhì)而產(chǎn)生的食物特異性抗體。目前已發(fā)現(xiàn)高IgG4水平與炎癥有關(guān)。
方法: 在患有慢性疼痛的男性和女性門診患者中測定IgG4水平（采用快速試驗(yàn)和酶聯(lián)免疫吸附試驗(yàn)（ELISA））。要求所有受試者在4周內(nèi)排除血清中IgG4抗體水平較高的所有食物。在個性化排除飲食期之前（隨訪1）和之后（隨訪2）進(jìn)行疼痛和生活質(zhì)量問卷調(diào)查。采用視覺模擬量表(VAS)、意大利疼痛問卷(QUID)和馬戈利斯(MA)問卷測定疼痛強(qiáng)度、疼痛特征和疼痛程度，采用健康簡表調(diào)查(SF-36)和情緒狀態(tài)量表(POMS)檢測生活質(zhì)量和情緒狀態(tài)。對所有受試者的營養(yǎng)狀況進(jìn)行了評估。受試者組為育齡婦女（絕經(jīng)前）、絕經(jīng)至少1年的婦女和男性。
結(jié)果：54名患有慢性疼痛的受試者(12名神經(jīng)性疼痛， 14名彌漫性疼痛，11名頭痛， 17名腰痛)完成了兩次隨訪和1個月的排除飲食。在第1次隨訪中，47名（87%）受試者對至少一種食物含有中/高水平的IgG4抗體。IgG4水平最高的食物是蛋類、乳制品、谷物和干果。在第2次隨訪中，IgG4水平降低、升高或不變均有呈現(xiàn)。在所有組中，4周的排除飲食導(dǎo)致所有疼痛指標(biāo)顯著降低，生活質(zhì)量參數(shù)改善。特別是在第2次隨訪時， VAS評分下降了50%以上。
結(jié)論：基于IgG4抗體水平的食物消除飲食可有效減輕慢性疼痛患者的疼痛并改善其生活質(zhì)量。


延伸閱讀
Pain Ther
Food-Specific IgG4 Antibody-Guided Exclusion Diet Improves Conditions of Patients with Chronic Pain
DOI: org/10.1007/s40122-022-00391-z
Abstract:
Introduction: Chronic pain is related to gastrointestinal (GI) functions because food components affect inflammation and pain through their action on the GI immune and/or neural system and because many analgesics interact with the gut to alter its structure and function. Immunoglobulin G4 (IgG4) are food-specific antibodies resulting from exposure of the gut immune system to nutrients. High IgG4 levels have been found to be associated with inflammation.
Methods: IgG4 were determined (both with the rapid test and enzyme-linked immunosorbent assay, ELISA) in men and women outpatients with chronic pain. All subjects were asked to exclude for 4 weeks all foods to which they had high blood levels of IgG4 antibodies. Pain and quality of life questionnaires were administered before (visit 1) and after (visit 2) the personalized exclusion diet period. Visual analogue scale (VAS), Italian Pain Questionnaire (QUID) and Margolis (MA) questionnaires were administered to determine pain intensity, pain features and pain extent, while Short Form Health Survey (SF-36) and Profile of Mood States (POMS) were used to test the quality of life and mood state. The nutritional status was evaluated in all subjects. Subject groups were women of reproductive age (pre-MW), women in menopause for at least 1 year (MW) and men.
Results: Fifty-four subjects with chronic pain(n = 12 neuropathic, n = 14 diffuse pain, n = 11 headache, n = 17 low back pain) completed the two visits and the 1-month exclusion diet. Atvisit 1, 47 (87%) subjects showed medium/high levels of IgG4 to at least one food. The foods showing the highest IgG4 values were eggs, dairy products, cereals and dried fruit. At visit 2, IgG4 levels were decreased, increased or unchanged. In all groups, the 4-week exclusion diet resulted in a significant reduction in all pain measures and an improvement of quality of life parameters. In particular, at visit 2, the VAS score determined in the morning decreased by more than 50%.
Conclusions: A food elimination diet based on IgG4 antibody levels may be effective in reducing pain and improving quality of life in patients with chronic pain.
First Author:
Ilenia Casini
Correspondence:
Department of Medicine, Surgery and Neuroscience,University of Siena, Via Aldo Moro, 2, 53100 Siena,Italy
2023-03-03  Article