Guandalini S, Gupta P
Department of Pediatrics, Section of Gastroenterology, Hepatology, and Nutrition, University of Chicago, 5841 South Maryland Avenue, Chicago, IL 60637, USA.
Curr Gastroenterol Rep. 2001 Oct;3(5):385-91. doi: 10.1007/s11894-001-0080-x.
Celiac disease is a common and permanent condition caused by an abnormal immune response to ingested gluten in genetically susceptible individuals. Its proper diagnosis is very important even in patients presenting with mild symptoms because severe and debilitating complications may occur in celiac patients not following a strict gluten-free diet. In the past several years, important progress has been made not only in our understanding of the pathogenesis of this condition but also in the availability of tools to screen it. Antigliadin antibodies, once largely used for this purpose, have been basically replaced by the more costly but far more accurate antiendomysium antibodies. More recently, the enzyme-linked immunosorbent assay (ELISA), which measures the antibodies directed against the autoantigen responsible for the disease (tissue transglutaminase), has also been developed and tested as a screening tool. Currently, however, the poor positive predictive value of this test does not allow practitioners to diagnose celiac disease without the duodenal biopsy showing the typical morphologic changes.
乳糜泻是一种常见的永久性疾病，由遗传易感个体对摄入的麸质产生异常免疫反应引起。即使在症状轻微的患者中，其正确诊断也非常重要，因为不遵循严格无麸质饮食的乳糜泻患者可能会出现严重且使人衰弱的并发症。在过去几年中，不仅在我们对这种疾病发病机制的理解方面取得了重要进展，而且在筛查工具的可用性方面也取得了进展。抗麦醇溶蛋白抗体曾大量用于此目的，现已基本被成本更高但准确性更高的抗肌内膜抗体所取代。最近，酶联免疫吸附测定（ELISA）也已开发并作为一种筛查工具进行测试，该测定可测量针对导致该疾病的自身抗原（组织转谷氨酰胺酶）的抗体。然而，目前该测试的阳性预测值较低，使得从业者在十二指肠活检未显示典型形态学改变的情况下无法诊断乳糜泻。
