Hansson T, Dahlbom I, Hall J, Holtz A, Elfman L, Dannaeus A, Klareskog L
Department of Clinical Immunology, Uppsala University Hospital, Sweden.
J Pediatr Gastroenterol Nutr. 2000 Apr;30(4):379-84. doi: 10.1097/00005176-200004000-00006.
Highly discriminatory markers for celiac disease are needed to identify children with early mucosal lesions. The purposes of this study were to evaluate the clinical potential of circulating anti-tissue transglutaminase (tTG) immunoglobulin (Ig)A antibodies in the diagnosis of childhood celiac disease and to investigate the extent of autoreactivity of these antibodies.
Included in this retrospective study were samples from 22 children with biopsy-verified celiac disease, 23 control subjects with disease, and 22 healthy control subjects without any known gastrointestinal or inflammatory disorders. An enzyme-linked immunosorbent assay (ELISA) was used to measure the serum levels of IgA antibodies specific for human and guinea pig tTGs. All samples were also analyzed for antibodies to gliadin and endomysium (EMA).
The concentrations of IgA specific for human and guinea pig tTGs correlated with the small intestinal villous structure and the serum levels of IgA EMA. The tTG ELISAs exhibited a high specificity and sensitivity for detection of untreated celiac disease. The human erythrocyte IgA tTG ELISA had the highest sensitivity (100%) and a specificity of 98%. The IgA EMA method had a sensitivity of 95% and the highest specificity (100%) of all tests.
Our results provide additional support to the concept that anti-tTG IgA antibodies can be used as a highly discriminatory serologic marker for celiac disease and that measurements of these autoreactive antibodies may in the future be used as an alternative to the EMA test.
乳糜泻需要高度特异的标志物来识别早期黏膜病变的儿童。本研究的目的是评估循环抗组织转谷氨酰胺酶（tTG）免疫球蛋白（Ig）A抗体在儿童乳糜泻诊断中的临床潜力，并研究这些抗体的自身反应程度。
这项回顾性研究纳入了22例经活检证实为乳糜泻的儿童样本、23例患有疾病的对照受试者以及22例无任何已知胃肠道或炎症性疾病的健康对照受试者。采用酶联免疫吸附测定（ELISA）法检测血清中针对人和豚鼠tTG的IgA抗体水平。所有样本还分析了抗麦醇溶蛋白和抗肌内膜（EMA）抗体。
针对人和豚鼠tTG的IgA浓度与小肠绒毛结构及IgA EMA血清水平相关。tTG ELISA对未经治疗的乳糜泻检测具有高特异性和敏感性。人红细胞IgA tTG ELISA敏感性最高（100%），特异性为98%。IgA EMA法敏感性为95%，在所有检测中特异性最高（100%）。
我们的结果为以下观点提供了更多支持，即抗tTG IgA抗体可作为乳糜泻高度特异的血清学标志物，并且这些自身反应性抗体的检测未来可能用作EMA检测的替代方法。
