Serologic screening for celiac disease in children: a comparison between established assays and tests with deamidated gliadin-derived peptides plus conjugates for both IgA and IgG antibodies
Serologic screening for celiac disease in children: a comparison between established assays and tests with deamidated gliadin-derived peptides plus conjugates for both IgA and IgG antibodies
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DOI：
10.1111/j.1600-0463.2009.02541.x
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发表时间：
2009-11-01
期刊：
影响因子：
2.8
通讯作者：
Olcen, Per
中科院分区：
文献类型：
--
作者：
Aberg, Anna-Karin;Olcen, Per
乳糜泻(CD)诊断活检患者的选择主要依据抗组织转谷氨酰胺酶(TTG)、抗内膜脂蛋白(EMA)和抗醇溶蛋白(AGA)IgA等血清学筛查试验的结果。使用包括IgA和IgG抗体的去胺化醇溶蛋白衍生多肽(DGP)的新测试已经被开发出来，以覆盖IgA缺乏的血清。此外，无论有没有人红血球衍生的tTG，IgA和Ig G DGP联合检测都可能提供优势。为了探讨新的联合试验的筛查准确性，对167名3岁以下儿童的血清进行了检测。其中32名儿童接受了与血清学有关的活检，24名儿童接受了组织病理CD检查。DGP及联合检测结果与IgA抗体tTG、EMA、AGA检测结果一致，均能诊断出24例CD中的21例。24例CD患者中有2例仅AGA-IgA阳性(2/24)，而24例CD患者中有2例AGA-IgA阴性，其余各项均阳性。这些结果提出了这样一个问题：醇溶蛋白抗原的修饰是否不仅减少了假阳性，而且还提供了更多的假阴性结果，这是对一种重要疾病的筛查测试的主要缺陷。必须进行进一步的研究来探索这一点。我们的结果还强调，儿童CD的血清学筛查不能仅基于一项测试。
Selection of patients for diagnostic biopsy concerning celiac disease (CD) is mainly guided by the results with serological screening tests like anti-tissue-transglutaminase (tTG), anti-endomysium (EmA) and anti-gliadin (AGA) IgA. New tests using deamidated gliadin-derived peptides (DGP) including both IgA and IgG antibodies have been developed, to cover the IgA-deficient sera. In addition, a combined IgA and IgG DGP test, with or without human erythrocyte-derived tTG, offers possible advantages. In order to explore the screening accuracy of the new combination tests sera from 167 children below 3 years of age were assayed. Biopsy had been taken in connection with serology in 32 of these children, 24 with histopathological CD. The results with the DGP and the combined test were congruent with the IgA antibody tests for tTG, EmA and AGA, all identifying 21 of 24 of the CD cases. Two of the CD patients were AGA-IgA positive only (2/24), while 2 of 24 sera were AGA-IgA negative but positive in all the other tests. These results raises the question whether the modifications of the gliadin antigen not only decrease false positivity but also give more false-negative results, a major drawback for a screening test for an important disease. Further studies have to be undertaken to explore this. Our results also stress that serologic screening of CD in children cannot be based on one test only.