European Society for Pediatric Gastroenterology, Hepatology, and Nutrition Guidelines for the Diagnosis of Coeliac Disease
European Society for Pediatric Gastroenterology, Hepatology, and Nutrition Guidelines for the Diagnosis of Coeliac Disease
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DOI：
10.1097/mpg.0b013e31821a23d0
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发表时间：
2012-01-01
影响因子：
2.9
通讯作者：
Zimmer, K. P.
中科院分区：
文献类型：
--
作者：
Husby, S.;Koletzko, S.;Zimmer, K. P.
目的：欧洲儿科胃肠病学、肝病学和营养学会（ESP-GHAN）的乳糜泻（CD）诊断标准于1990年发表。从那时起，自身抗原CD，组织转氨酶，已被确定; CD的看法已经改变了，从一个相当罕见的肠病的一个共同的多器官疾病强烈依赖于人类白细胞抗原（HLA）-DQ 2和HLA-DQ 8的单倍型;和CD特异性抗体测试已经improved.Methods：一个小组的17名专家定义CD和开发新的诊断标准的基础上的德尔菲过程。采用不同的诊断方法对两组患者进行定义，以诊断CD：有提示CD症状的儿童（第1组）和CD风险增加的无症状儿童（第2组）。2004年美国国立卫生研究院/机构的医疗保健研究和质量报告和系统的文献检索抗体检测CD在儿科患者涵盖了2004年至2009年的基础上，CD特异性抗体testing.Results的循证建议：在第1组，CD的诊断是基于症状，阳性血清学，组织学是一致的CD。如果免疫球蛋白A抗组织转氨酶2型抗体滴度高（>正常上限的10倍），则可以选择通过应用严格的实验室检查方案来诊断CD，而无需十二指肠活检。在第2组中，CD的诊断基于阳性血清学和组织学。HLA-DQ 2和HLA-DQ 8测试是有价值的，因为CD是不可能的，如果两个单倍型都是negative.Conclusions：新的指南的目的是达到一个高的诊断准确性，并减少患者及其家属的负担。应前瞻性评估这些指南在临床实践中的表现。
Objective: Diagnostic criteria for coeliac disease (CD) from the European Society for Paediatric Gastroenterology, Hepatology, and Nutrition (ESP-GHAN) were published in 1990. Since then, the autoantigen in CD, tissue transglutaminase, has been identified; the perception of CD has changed from that of a rather uncommon enteropathy to a common multiorgan disease strongly dependent on the haplotypes human leukocyte antigen (HLA)-DQ2 and HLA-DQ8; and CD-specific antibody tests have improved.Methods: A panel of 17 experts defined CD and developed new diagnostic criteria based on the Delphi process. Two groups of patients were defined with different diagnostic approaches to diagnose CD: children with symptoms suggestive of CD (group 1) and asymptomatic children at increased risk for CD (group 2). The 2004 National Institutes of Health/Agency for Healthcare Research and Quality report and a systematic literature search on antibody tests for CD in paediatric patients covering the years 2004 to 2009 was the basis for the evidence-based recommendations on CD-specific antibody testing.Results: In group 1, the diagnosis of CD is based on symptoms, positive serology, and histology that is consistent with CD. If immunoglobulin A anti-tissue transglutaminase type 2 antibody titers are high (> 10 times the upper limit of normal), then the option is to diagnose CD without duodenal biopsies by applying a strict protocol with further laboratory tests. In group 2, the diagnosis of CD is based on positive serology and histology. HLA-DQ2 and HLA-DQ8 testing is valuable because CD is unlikely if both haplotypes are negative.Conclusions: The aim of the new guidelines was to achieve a high diagnostic accuracy and to reduce the burden for patients and their families. The performance of these guidelines in clinical practice should be evaluated prospectively.