Matusiewicz Krzysztof, Iwańczak Barbara, Matusiewicz Małgorzata, Iwańczak Franciszek
Akademia Medyczna we Wroclawiu, II Katedra i Klinika Pediatrii, Gastroenterologii i Zywienia.
Pol Merkur Lekarski. 2006 Jan;20(115):17-21.
Tissue transglutaminase (tTG) plays a decisive role in the pathomechanism of celiac disease. Unchanged gliadin peptides bind to HLA-DQ2 with a week affinity, after that they are recognized by gliadin specific T-lymphocytes and the whole immune reaction is started which damages intestine mucous and causes the release of tTG. Tissue transglutaminase deaminates gliadin peptides enhancing the whole process. The aim of this study was determination of correlation between antiendomysial antibodies and anti-tissue transglutaminase antibodies in children with celiac disease, and the assessment of their usefulness in the diagnosis of celiac disease.
109 children, aged 6 moths to 16 years (average 8.8 years) were included into the study. In all children an intestine biopsy was performed and/or antiendomysial antibodies were determined. In all children tissue transglutaminase antibodies were measured. Antibodies against tissue transglutaminase were determined using ELISA method. Antiendomysial antibodies were determined using the immunofluorescence method.
In patients with normal mucous with lack of lymphocyte infiltration no IgAEmA were present in the blood. In the groups with subtotal and total villous atrophy all IgAEmA titres were positive. A positive titre of IgAEmA was observed only in childrerl with villous atrophy, which yields specificity of the test of 100%, sensitivity was 81%. Sensitivity of the anti-tTG antibodies test for detecting villous atrophy was 83% for IgA and 52% for IgG. There is a positive correlation between IgAEmA and anti-tTG antibodies.
High sensitivity and specificity of determination of antibodies against tTG in IgA class causes that these tests may serve as a screening test in diagnosis and monitoring of celiac disease in children.
组织转谷氨酰胺酶（tTG）在乳糜泻的发病机制中起决定性作用。未改变的麦醇溶蛋白肽以弱亲和力与HLA - DQ2结合，之后它们被麦醇溶蛋白特异性T淋巴细胞识别，从而启动整个免疫反应，该反应会损害肠黏膜并导致tTG释放。组织转谷氨酰胺酶使麦醇溶蛋白肽脱氨基，从而增强整个过程。本研究的目的是确定乳糜泻患儿抗肌内膜抗体和抗组织转谷氨酰胺酶抗体之间的相关性，并评估它们在乳糜泻诊断中的效用。
109名年龄在6个月至16岁（平均8.8岁）的儿童被纳入研究。对所有儿童进行了肠活检和/或测定了抗肌内膜抗体。对所有儿童均检测了组织转谷氨酰胺酶抗体。采用酶联免疫吸附测定（ELISA）法测定抗组织转谷氨酰胺酶抗体。采用免疫荧光法测定抗肌内膜抗体。
黏膜正常且无淋巴细胞浸润的患者血液中不存在IgAEmA。在部分绒毛萎缩和完全绒毛萎缩组中，所有IgAEmA滴度均为阳性。仅在绒毛萎缩患儿中观察到IgAEmA滴度呈阳性，该检测的特异性为100%，敏感性为81%。抗tTG抗体检测对检测绒毛萎缩的敏感性，IgA为83%，IgG为52%。IgAEmA与抗tTG抗体之间存在正相关。
IgA类抗tTG抗体检测具有高敏感性和特异性，这使得这些检测可作为儿童乳糜泻诊断和监测的筛查试验。
