乳糜泻的自身抗体与组织发生
Autoantibodies and histogenesis of celiac disease.
作者信息
Rostami Kamran, Mulder Chris J J, Stapel Steven, von Blomberg B Mary E, Kerckhaert Jo, Meijer Jos W R, Peńa Salvador A, Heymans Hugo S A
机构信息
Department of Gastroenterology Withybush General Hospital, Pembrokeshire, Haverfordwest, UK.
出版信息
Rom J Gastroenterol. 2003 Jun;12(2):101-6.
OBJECTIVE
Autoantibodies are used as markers for celiac disease (CD) identifying patients with mucosal lesions. The purpose of this study was to evaluate the sensitivity and role of the autoantibodies such as IgA antiendomysium (EMA), IgA antigliadin (AGA) and the IgA antitissue transglutaminase (tTGA) in histogenesis of celiac disease.
METHODS
Seventy-nine cases including 30 untreated celiacs, 5 celiacs on gluten-free diet (GFD), 41 first degree relatives and 3 non-relatives suspected for CD were investigated. Three untreated celiacs with IgA deficiency were excluded from this study group. IgA antibodies to tTGA were determined by ELISA, as described before. Twelve of 41 relatives and 2 cases of non relatives suspected with positive serology underwent a small intestinal biopsy. Results were correlated with the degrees of abnormality of the intestinal mucosa in patients with CD. Intestinal biopsies obtained from study population were evaluated for histological quantification.
RESULTS
Celiacs and suspected cases with positive EMA/AGA and or tTGA showed shorter villi (p < 0.007) and/or a higher number of intraepithelial lymphocytes (IEL) (p < 0.035). The sensitivity of serology (EMA, AGA, tTGA) in patients with Marsh IIIc was 100%. However, in patients with Marsh IIIa the sensitivity for EMA, AGA, and tTGA was 40%, 50% and 20% respectively.
CONCLUSIONS
The appearance of antibodies is related to the degree of mucosal infiltration by IELs. Although tTGA, like EMA provide a highly sensitive parameter for the detection of celiacs with severe mucosal damage, it appears to be less sensitive (even less than AGA) in celiac patients with milder histopathological abnormalities. However, it should be recognized that the substantial part of the celiac population present with these milder forms of mucosal abnormalities. Using tTGA as a single test in screening may result in missing up to 60-70% of celiacs with mild mucosal abnormalities. Combination with other screening tests (at least with AGA) is essential and strongly recommended
目的
自身抗体被用作乳糜泻（CD）的标志物，以识别患有黏膜病变的患者。本研究的目的是评估抗肌内膜IgA（EMA）、抗麦醇溶蛋白IgA（AGA）和抗组织转谷氨酰胺酶IgA（tTGA）等自身抗体在乳糜泻组织发生中的敏感性和作用。
方法
对79例患者进行了研究，其中包括30例未经治疗的乳糜泻患者、5例采用无麸质饮食（GFD）的乳糜泻患者、41例一级亲属以及3例疑似患有CD的非亲属。本研究组排除了3例未经治疗且伴有IgA缺乏的乳糜泻患者。如前所述，采用酶联免疫吸附测定法（ELISA）测定抗tTGA的IgA抗体。41例亲属中的12例以及2例血清学检测呈阳性的疑似非亲属接受了小肠活检。结果与CD患者肠黏膜异常程度相关。对研究人群获取的肠道活检组织进行组织学定量评估。
结果
EMA/AGA和/或tTGA呈阳性的乳糜泻患者及疑似病例显示绒毛较短（p < 0.007）和/或上皮内淋巴细胞（IEL）数量较多（p < 0.035）。在马什IIIc级患者中，血清学检查（EMA、AGA、tTGA）的敏感性为100%。然而，在马什IIIa级患者中，EMA、AGA和tTGA的敏感性分别为40%、50%和20%。
结论
抗体的出现与IELs的黏膜浸润程度相关。尽管tTGA与EMA一样，为检测严重黏膜损伤的乳糜泻患者提供了一个高度敏感的参数，但在组织病理学异常较轻的乳糜泻患者中，其敏感性似乎较低（甚至低于AGA）。然而，应该认识到，相当一部分乳糜泻患者表现为这些较轻形式的黏膜异常。在筛查中仅使用tTGA进行检测可能会导致多达60 - 70%黏膜异常较轻的乳糜泻患者漏诊。与其他筛查试验（至少与AGA联合）相结合至关重要，强烈推荐。
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