Antibodies against deamidated gliadin peptides identify adult coeliac disease patients negative for antibodies against endomysium and tissue transglutaminase
Antibodies against deamidated gliadin peptides identify adult coeliac disease patients negative for antibodies against endomysium and tissue transglutaminase
复制标题
DOI：
10.1111/j.1365-2036.2010.04337.x
复制
发表时间：
2010-07-15
影响因子：
7.6
通讯作者：
Strom, M.
中科院分区：
文献类型：
--
作者：
Dahle, C.;Hagman, A.;Strom, M.
本研究的目的是评估抗脱酰胺麦胶蛋白肽抗体与传统乳糜泻标志物的诊断价值。目的评价抗脱酰胺麦胶蛋白肽（DGP）抗体的诊断价值。方法对176例未进行组织转谷氨酰胺酶（tTG）或肌内膜（EmA）抗体分析的成人内镜检查血清进行回顾性分析，采用elisa检测DGP或DGP和tTG混合IgA/IgG抗体，并与IgA-tTG和EmA进行比较。79人被诊断患有乳糜泻。结果除IgA/IgG-DGP/ tTG外，所有受试者工作特性分析均验证了生产厂家的截止限值。在无IgA缺乏的血清中，IgA/IgG-DGP的敏感性（0.85-0.87）高于IgA- ttg（0.76）和EmA（0.61）。所有试验均显示高特异性（0.95-1.00）。18例乳糜泻血清IgA- ttg呈阴性，其中9例IgA/IgG-DGP呈阳性。50 ~ 70岁乳糜泻患者血清IgA- ttg（50%）和IgA/IgG-DGP（36%）阴性高于年轻患者（分别为15%和8%）（P < 0.01）。4例IgA缺乏患者中有3例IgA/IgG-DGP检测呈阳性。结论在这项未选择IgA- ttg /EmA患者的研究中，IgA/IgG-DGP识别出肌内膜和组织转谷氨酰胺酶抗体阴性的成人乳糜泻患者，因此在这方面是公正的。老年乳糜泻患者血清学常为阴性；因此，在排除乳糜泻之前，应大量进行小肠活检。
BackgroundThis study was done to evaluate the diagnostic utility of antibodies against deamidated gliadin peptides compared to traditional markers for coeliac disease. Aim To evaluate diagnostic utility of antibodies against deamidated gliadin peptide (DGP).MethodsSera from 176 adults, referred for endoscopy without previous analysis of antibodies against tissue transglutaminase (tTG) or endomysium (EmA), were retrospectively analysed by ELISAs detecting IgA/IgG antibodies against DGP or a mixture of DGP and tTG, and compared with IgA-tTG and EmA. Seventy-nine individuals were diagnosed with coeliac disease.ResultsReceiver operating characteristic analyses verified the manufacturers' cut-off limits except for IgA/IgG-DGP/ tTG. In sera without IgA deficiency, the sensitivity was higher for IgA/IgG-DGP (0.85-0.87) compared with IgA-tTg (0.76) and EmA (0.61). All tests showed high specificity (0.95-1.00). Eighteen coeliac disease-sera were negative regarding IgA-tTG, nine of which were positive for IgA/IgG-DGP. Sera from coeliac disease-patients >70 years were more often negative for IgA-tTG (50%) and IgA/IgG-DGP (36%) than younger patients (15% and 8% respectively) (P < 0.01). Three of the four IgA-deficient patients were positive in the IgA/IgG-DGP assay.ConclusionsIn this study of patients unselected regarding IgA-tTg/EmA, thus unbiased in this respect, IgA/IgG-DGP identified adult coeliac disease patients negative for antibodies against endomysium and tissue transglutaminase. Serology is often negative in elderly patients with coeliac disease; a small bowel biopsy should therefore be performed generously before coeliac disease is excluded.