Kotze L M, Utiyama S R, Nisihara R M, Zeni M P, de Sena M G, Amarante H M
Service of Gastroenterology and Digestive Endoscopy, Hospital Cajuru Service of Gastroenterology, Federal University of Paraná, Curitiba, PR, Brazil.
Arq Gastroenterol. 2001 Apr-Jun;38(2):94-103. doi: 10.1590/s0004-28032001000200004.
Literature data have shown high specificity of antiendomysial antibodies (EmA IgA) in celiac disease. The scarcity of Brazilian reports concerning this subject motivated the present study.
To determine the sensitivity and specificity of antiendomysial IgA antibodies in Brazilian celiac patients at diagnosis and after treatment, to confirm patient adherence to a gluten-free diet and to screen first-degree relatives.
An extensive clinical and serological study was performed by investigating the presence of these antibodies in 392 individuals from Southern Brazil. Indirect immunofluorescence using human umbilical cord as substrate was employed and the total levels of IgA were determined by turbidimetry in all groups. The study was conducted on 57 celiac patients (18 at diagnosis, 24 who adhered to a gluten-free diet and 15 with marked or slight transgression of the diet), 115 relatives of celiac patients (39 families), 94 patients with other gastrointestinal diseases, and 126 healthy individuals from the general population.
The results demonstrated 100% positivity for the recently diagnosed patients and for those consuming gluten, in contrast to the patients who complied with the diet (0%). In the control group one individual was positive, but refused to undergo a biopsy. In the group of other gastrointestinal diseases, one positive patient presented ulcerative colitis, Down's syndrome and epilepsy, and the intestinal biopsy was diagnostic for celiac disease. These data showed 99.3% specificity for the test. Eighteen relatives were positive for antiendomysial antibodies IgA (15.65%), and comparison with the healthy population revealed a significant difference. An intestinal biopsy was obtained from seven subjects (one with total villous atrophy and six without alterations in the mucosal architecture, but all with a high number of intra-epithelial lymphocytes).
The method revealed 100% sensitivity and 99.3% specificity. Because it is not an invasive method it can be used for the screening of atypical and latent forms of celiac disease to avoid serial biopsies and to control adherence to a gluten-free diet with implications in the prevention of malignancy in celiac disease.
文献数据表明抗肌内膜抗体（EmA IgA）在乳糜泻中具有高特异性。巴西关于该主题的报告稀缺促使了本研究。
确定巴西乳糜泻患者诊断时及治疗后抗肌内膜IgA抗体的敏感性和特异性，确认患者对无麸质饮食的依从性并筛查一级亲属。
通过调查巴西南部392名个体中这些抗体的存在情况进行了一项广泛的临床和血清学研究。采用以人脐带为底物的间接免疫荧光法，并通过比浊法测定所有组中的IgA总水平。该研究针对57名乳糜泻患者（18名诊断时、24名坚持无麸质饮食以及15名有明显或轻微饮食违规者）、115名乳糜泻患者的亲属（39个家庭）、94名患有其他胃肠道疾病的患者以及126名普通人群中的健康个体进行。
结果显示，最近诊断的患者和食用麸质的患者抗体阳性率为100%，而遵循饮食的患者为0%。在对照组中，有1人呈阳性，但拒绝接受活检。在其他胃肠道疾病组中，1名阳性患者患有溃疡性结肠炎、唐氏综合征和癫痫，肠道活检诊断为乳糜泻。这些数据显示该检测的特异性为99.3%。18名亲属抗肌内膜抗体IgA呈阳性（15.65%），与健康人群相比有显著差异。对7名受试者进行了肠道活检（1名有全绒毛萎缩，6名黏膜结构无改变，但均有大量上皮内淋巴细胞）。
该方法显示出100%的敏感性和99.3%的特异性。由于它不是侵入性方法，可用于筛查乳糜泻的非典型和潜在形式，以避免连续活检，并控制对无麸质饮食的依从性，这对预防乳糜泻中的恶性肿瘤具有重要意义。
