Area de Pediatría, Facultad de Medicina y Hospital Clínico, Universidad de Valladolid, Spain.
An Esp Pediatr. 2000 Dec;53(6):533-41.
In recent years, the high frequency of atypical cases of celiac disease (CD) and of forms of this disease with minor symptoms has prompted the search for analytical markers that may support indications for intestinal biopsy. The commonest tests are those for serum class IgG and IgA antigliadin antibodies (IgG-AGA, IgA-AGA) and IgA antiendomysial antibodies (IgA-EmA).
We report our 10 year experience of studying AGA in 1,075 serum samples from patients with CD and IgA-EmA in 534 samples. The serological markers were compared with 152 intestinal biopsies performed simultaneously with the other tests.
In patients with severe intestinal atrophy the sensitivity of IgA-AGA (91%) and IgA-EmA (94%) was high. IgA-EmA and the latter showed the highest positive (88%) and negative (97%) predictive values. In all patients, IgA-EmA positivity coincided with alterations in the biopsy. Determination of IgA-EmA was also the most efficient marker for monitoring the gluten free diet phase. However, in patients in whom minimal histological changes were found in the intestinal mucosa, none of the markers was sufficiently accurate.
IgA- EmA antibodies are the most accurate serological marker of CD. In view of these results and the estimated prevalence of the disease, protocols for the use of serological markers are proposed for the differential diagnosis of malabsorption symptoms, for use in patients at low and high risk of CD and for the followup of those with a diagnosis of CD.
近年来，乳糜泻（CD）非典型病例以及症状较轻的该疾病形式的高发性促使人们寻找可能有助于肠道活检指征的分析标志物。最常见的检测是血清IgG和IgA抗麦胶蛋白抗体（IgG-AGA、IgA-AGA）以及IgA抗肌内膜抗体（IgA-EmA）检测。
我们报告了对1075例CD患者血清样本进行AGA检测以及对534例样本进行IgA-EmA检测的10年经验。将这些血清学标志物与同时进行的其他检测时所做的152例肠道活检结果进行比较。
在严重肠道萎缩患者中，IgA-AGA（91%）和IgA-EmA（94%）的敏感性较高。IgA-EmA及后者显示出最高的阳性（88%）和阴性（97%）预测值。在所有患者中，IgA-EmA阳性与活检中的改变一致。IgA-EmA检测也是监测无麸质饮食阶段最有效的标志物。然而，在肠道黏膜组织学改变轻微的患者中，没有一种标志物足够准确。
IgA-EmA抗体是CD最准确的血清学标志物。鉴于这些结果以及该疾病的估计患病率，提出了血清学标志物的使用方案，用于吸收不良症状的鉴别诊断、用于CD低风险和高风险患者以及用于CD确诊患者的随访。
