Rostami K, Kerckhaert J, Tiemessen R, von Blomberg B M, Meijer J W, Mulder C J
Department of Hepatogastroenterology, Rinjstate Hospital, Arnhem, The Netherlands.
Am J Gastroenterol. 1999 Apr;94(4):888-94. doi: 10.1111/j.1572-0241.1999.983_f.x.
We have undertaken a study to assess the efficiency of serological tests in the diagnosis of celiac disease (CD) during the period January 1, 1994 to January 7, 1997. Our aim was to evaluate the sensitivity of IgA antiendomysium (EMA) and IgA antigliadin (AGA) with regard to the degree of histological abnormality in biopsy specimens of small intestine in untreated celiac disease patients and first-degree relatives.
The study population comprised 101 cases: 85 untreated celiac patients and 16 first-degree relatives with a mean age of 42 yr (range, 2-76 yrs). Sixteen of 85 were excluded from study because they did not satisfy the study or diagnostic criteria of CD. EMA and AGA have been compared with the degree of villous atrophy (VA) in 69 celiac patients and 16 relatives according to the Marsh criteria of 1992. We divided the Marsh III histology into three subgroups as follows: Marsh IIIa (partial VA), Marsh IIIb (subtotal VA), and Marsh IIIc (total villous atrophy).
The specificity and positive predictive value of EMA for CD was excellent, because all EMA-positive patients (n = 42) were diagnosed with CD. The sensitivity of EMA, however, differed between CD subgroups; in patients with total VA, the sensitivity of EMA was 100% (17/17). However, in patients with partial VA (Marsh IIIa), the sensitivity of EMA was disappointing, only 9/29 (31%). Three of 72 celiacs with Marsh IIIb and Marsh IIIc had IgA deficiency and were excluded from the study. Elevated AGA has been detected in the sera of 39 of 69 (62%) patients. A combination of EMA and AGA tests showed a sensitivity of 76% (53/69). None of 16 first-degree relatives with Marsh I-II had positive EMA.
Interpretation of negative serology needs great awareness. Although EMA sensitivity in total villous atrophy is excellent, in partial villous atrophy the sensitivity of EMA appears to be disappointing. Our experience shows that EMA and AGA have only limited value in screening programs for CD.
我们开展了一项研究，以评估1994年1月1日至1997年1月7日期间血清学检测在乳糜泻（CD）诊断中的效率。我们的目的是评估未经治疗的乳糜泻患者及一级亲属小肠活检标本中，IgA抗肌内膜（EMA）和IgA抗麦胶蛋白（AGA）相对于组织学异常程度的敏感性。
研究人群包括101例：85例未经治疗的乳糜泻患者和16例一级亲属，平均年龄42岁（范围2 - 76岁）。85例中有16例因不满足CD的研究或诊断标准而被排除在研究之外。根据1992年的马什标准，将69例乳糜泻患者和16例亲属的EMA和AGA与绒毛萎缩（VA）程度进行了比较。我们将马什III级组织学分为以下三个亚组：马什IIIa（部分VA）、马什IIIb（大部分VA）和马什IIIc（完全绒毛萎缩）。
EMA对CD的特异性和阳性预测值极佳，因为所有EMA阳性患者（n = 42）均被诊断为CD。然而，EMA的敏感性在CD亚组之间有所不同；在完全VA患者中，EMA的敏感性为100%（17/17）。然而，在部分VA（马什IIIa）患者中，EMA的敏感性令人失望，仅为9/29（31%）。72例马什IIIb和马什IIIc级的乳糜泻患者中有3例存在IgA缺乏，被排除在研究之外。69例患者中有39例（62%）血清中检测到AGA升高。EMA和AGA检测联合显示敏感性为76%（53/69）。16例马什I - II级的一级亲属中无一例EMA呈阳性。
血清学阴性结果的解读需要高度警惕。虽然EMA在完全绒毛萎缩中的敏感性极佳，但在部分绒毛萎缩中，EMA的敏感性似乎令人失望。我们的经验表明，EMA和AGA在CD筛查项目中的价值有限。
