Bardella M T, Trovato C, Cesana B M, Pagliari C, Gebbia C, Peracchi M
Dept Gastroenterology, University of Milan, IRCCS Ospedale Maggiore, Italy.
Dig Liver Dis. 2001 Jun-Jul;33(5):426-31. doi: 10.1016/s1590-8658(01)80015-3.
Anti-gliadin and anti-endomysium antibodies are useful markers in the screening and follow-up of coeliac disease. The recent finding that tissue transglutaminase is the main auto-antigen of anti-endomysium has led to the discovery of anti-tissue transglutaminase antibodies.
To compare, in a prospective study, the diagnostic accuracy of anti-tissue transglutaminase, anti-gliadin and anti-endomysium antibodies in a large series of adult patients.
The study involved 80 consecutive subjects undergoing upper gastrointestinal tract endoscopy for suspected coeliac disease (subsequently confirmed in 40 cases), 195 coeliac patients on a gluten-free diet, and 70 patients with different gastrointestinal disor ders and normal duodenal histology. Anti-gliadin, anti-endomysium and anti-tissue transglutaminase antibodies levels were measured using commercial kits.
The diagnostic sensitivity and specificity of anti-gliadin, anti-endomysium and anti-tissue transglutaminase antibodies were, respectively, 95% and 89.1%, 100% and 97.3%, and 100% and 98.2%: the agreement between the markers was substantial or almost perfect. In terms of follow-up, the positivity of the markers varied according to the strict adherence to, and duration of the gluten-free diet; the agreement between antiendomysium and anti-tissue transglutaminase antibodies was almost perfect.
Anti-endomysium and anti-tissue transglutaminase antibodies are both highly efficient for routine laboratory screening: the choice of one or the other will depend on the available facilities. However, neither can replace intestinal biopsy for general population screening because, in this case, their respective positive predictive values are only 15.7% and 21.8%. During follow-up, anti-gliadin retain their value as an early predictor of gluten ingestion.
抗麦醇溶蛋白抗体和抗肌内膜抗体是乳糜泻筛查及随访的有用标志物。最近发现组织转谷氨酰胺酶是抗肌内膜的主要自身抗原，从而发现了抗组织转谷氨酰胺酶抗体。
在一项前瞻性研究中比较大量成年患者中抗组织转谷氨酰胺酶、抗麦醇溶蛋白和抗肌内膜抗体的诊断准确性。
该研究纳入了80例因疑似乳糜泻接受上消化道内镜检查的连续受试者（随后40例确诊）、195例采用无麸质饮食的乳糜泻患者以及70例患有不同胃肠道疾病且十二指肠组织学正常的患者。使用商用试剂盒检测抗麦醇溶蛋白、抗肌内膜和抗组织转谷氨酰胺酶抗体水平。
抗麦醇溶蛋白、抗肌内膜和抗组织转谷氨酰胺酶抗体的诊断敏感性和特异性分别为95%和89.1%、100%和97.3%、100%和98.2%：这些标志物之间的一致性很高或几乎完美。在随访方面，标志物的阳性率根据对无麸质饮食的严格遵守情况和持续时间而有所不同；抗肌内膜和抗组织转谷氨酰胺酶抗体之间的一致性几乎完美。
抗肌内膜和抗组织转谷氨酰胺酶抗体在常规实验室筛查中都非常有效：选择其中一种将取决于可用设备。然而，两者都不能替代对普通人群的肠道活检，因为在这种情况下，它们各自的阳性预测值仅为15.7%和21.8%。在随访期间，抗麦醇溶蛋白作为麸质摄入的早期预测指标仍有价值。
