What is the role of serologic testing in celiac disease? A prospective, biopsy-confirmed study with economic analysis
What is the role of serologic testing in celiac disease? A prospective, biopsy-confirmed study with economic analysis
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DOI：
10.1016/j.cgh.2007.12.008
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发表时间：
2008-03-01
影响因子：
12.6
通讯作者：
Sanders, David S.
中科院分区：
文献类型：
--
作者：
Hopper, Andrew D.;Hadjivassiliou, Marios;Sanders, David S.
背景与目的：乳糜泻的最佳血清学检测方法及随访评价仍存在争议。我们的目的是利用十二指肠活检的金标准来评价目前诊断乳糜泻的所有免疫检测方法。我们还评估了组织转谷氨酰胺酶（tTG）抗体是否是组织学严重程度的定量标记。方法：连续招募没有已知乳糜泻诊断的成人胃镜检查患者（1组）。同时，确诊为乳糜泻的无麸质饮食超过1年的患者接受重复十二指肠活检（组2）。所有患者均行十二指肠活检，并进行免疫球蛋白（Ig）A和人免疫球蛋白（Ig）A- ttg、iga -麦胶蛋白、igg -麦胶蛋白和iga -肌内膜抗体的血清学分析。结果：第一组共招募了2000例患者。77例（3.9%）患者被诊断为新发乳糜泻。IgA tTG的敏感性、特异性、阳性预测值、阴性预测值分别为90.9%、90.9%、28.6%、99.6%。采用先tTG后EMU的两步法，其敏感性、特异性、阳性预测值和阴性预测值分别为85.7%、98.6%、71.7%和99.7%。当考虑检测成人乳糜泻时，使用非脱酰胺的IgA/IgG麦胶蛋白抗体没有额外的诊断益处。在第二组中，确定了48名无麸质饮食的乳糜泻患者。48例患者中有16例存在持续性绒毛萎缩，但16例患者中有7例（44%）tTG水平正常。结论：IgA tTG是乳糜泻的敏感标志物。正常的tTG水平不能预测无麸质饮食的乳糜泻患者绒毛萎缩的恢复。
Background & Aims: The optimal serologic tests for the detection of celiac disease and follow-up assessment remains controversial. Our aim was to evaluate all current immunologic assays for diagnosing celiac disease using the gold standard of duodenal biopsy. We also assessed whether tissue transglutaminase (tTG) antibody is a quantitative marker for histologic severity. Methods: Consecutive adult patients referred for gastroscopy without a previous known diagnosis of celiac disease were recruited (group 1). Concurrently, patients with a known diagnosis of celiac disease on a gluten-free diet for more than 1 year undergoing repeat duodenal biopsy were identified (group 2). All patients had duodenal biopsies and serologic analysis performed for immunoglobulin(Ig) A and antibodies to human immunoglobulin (Ig)A-tTG, IgA-gliadin, IgG-gliadin, and IgA-endomysial antibody. Results : Two thousand patients were recruited in the first group. Seventy-seven (3.9%) patients were diagnosed with new celiac disease. The sensitivity, specificity, positive predictive value, and negative predictive value for IgA tTG were 90.9%, 90.9%, 28.6%, and 99.6%. When adopting a 2-step, approach using tTG first and then EMU the sensitivity, specificity, positive predictive value, and negative predictive value was 85.7%, 98.6%, 71.7%, and 99.7%, respectively. The use of nondeamidated IgA/IgG gliadin antibodies conferred no additional diagnostic benefit when considering the detection of adult celiac disease. In the second group 48 patients with celiac disease on a gluten-free diet were identified. Sixteen of 48 of these patients had persisting villous atrophy, but 7 of 16 (44%) had a normal tTG level. Conclusions: IgA tTG alone is a sensitive marker for celiac disease. A normal tTG level does not predict recovery of villous atrophy in patients with celiac disease on a gluten-free diet.