Baldas V, Tommasini A, Trevisiol C, Berti I, Fasano A, Sblattero D, Bradbury A, Marzari R, Barillari G, Ventura A, Not T
Department of Pediatrics IRCCS Burlo Garofolo, Trieste, Italy.
Gut. 2000 Nov;47(5):628-31. doi: 10.1136/gut.47.5.628.
Coeliac disease is one of the commonest underdiagnosed diseases in general practice. The autoantigen recognised by the sera of patients with coeliac disease has recently been identified as tissue transglutaminase.
We evaluated a simple non-invasive immunological dot blot assay for coeliac disease, suitable for use by the general physician in the ambulatory setting. The sensitivity and specificity of this dot blot assay based on recognition of recombinant human transglutaminase were compared with those of antiendomysial antibodies and an enzyme linked immunosorbent assay.
Serum samples were analysed from 64 healthy controls, 58 first degree relatives of coeliacs, 74 diseased controls, and 70 biopsy confirmed untreated patients with coeliac disease. Dot blot assay and enzyme linked immunosorbent assay were performed using recombinant human transglutaminase as antigen.
The dot blot assay, which can be performed in 20 minutes, was positive in all 70 untreated coeliacs (sensitivity 100%). Among the three control groups, there were three false positive tests by dot blot (specificity 98%), all belonging to the group of healthy subjects. The antiendomysial antibodies test missed five untreated coeliac patients (sensitivity 93%) and was negative in all three control groups (specificity 100%). The specificity of the immunosorbent assay was 99% for IgA and 98% for IgG, while sensitivity was 93% for IgA, 47% for IgG, and 100% for IgA and IgG combined.
The dot blot assay is highly accurate in detecting untreated subjects with coeliac disease and can be performed in the general physician's medical office during the course of a routine examination. This innovative test is a practical, reliable alternative to both the immunofluorescent based antiendomysial test and immunosorbent assay for detection of transglutaminase antibodies for the diagnosis of coeliac disease.
乳糜泻是全科医疗中最常被漏诊的疾病之一。乳糜泻患者血清所识别的自身抗原最近已被确定为组织转谷氨酰胺酶。
我们评估了一种用于乳糜泻的简单非侵入性免疫斑点印迹检测法，适用于全科医生在门诊环境中使用。将基于重组人转谷氨酰胺酶识别的这种斑点印迹检测法的敏感性和特异性与抗肌内膜抗体检测法和酶联免疫吸附测定法进行比较。
分析了64名健康对照者、58名乳糜泻患者的一级亲属、74名疾病对照者以及70名经活检确诊未治疗的乳糜泻患者的血清样本。以重组人转谷氨酰胺酶为抗原进行斑点印迹检测法和酶联免疫吸附测定法。
可在20分钟内完成的斑点印迹检测法在所有70名未治疗乳糜泻患者中均呈阳性（敏感性100%）。在三个对照组中，斑点印迹检测法有3例假阳性（特异性98%），均属于健康受试者组。抗肌内膜抗体检测法漏诊了5名未治疗的乳糜泻患者（敏感性93%），在所有三个对照组中均为阴性（特异性100%）。免疫吸附测定法的特异性对于IgA为99%，对于IgG为98%，而敏感性对于IgA为93%，对于IgG为47%，对于IgA和IgG联合检测为100%。
斑点印迹检测法在检测未治疗的乳糜泻患者方面高度准确，并且可在全科医生的诊室中于常规检查过程中进行。这种创新检测法是用于诊断乳糜泻的检测转谷氨酰胺酶抗体的基于免疫荧光的抗肌内膜检测法和免疫吸附测定法的实用、可靠替代方法。
