Akbari Mohammad Reza, Mohammadkhani Ashraf, Fakheri Hafez, Javad Zahedi Mohammad, Shahbazkhani Bijan, Nouraie Mehdi, Sotoudeh Masoud, Shakeri Ramin, Malekzadeh Reza
Digestive Disease Research Centre, Tehran University of Medical Sciences, Tehran, Iran.
Eur J Gastroenterol Hepatol. 2006 Nov;18(11):1181-6. doi: 10.1097/01.meg.0000224477.51428.32.
Population-based studies for the prevalence of coeliac disease (CD) in west-Asian countries are scarce. We aimed to determine the prevalence of gluten-sensitive enteropathy (GSE) in the general population of northern and southern Iran, and evaluate the sensitivity and specificity of the anti-endomysial antibody (EMA) immunofluorescent test and the enzyme-linked immunosorbent assay-based test for determination of the IgA anti-tissue transglutaminase antibody (tTG-Ab) using the human recombinant transglutaminase antigen for the detection of CD in screening the asymptomatic adult population.
Using a stratified random sampling method we enrolled a total of 2799 individuals (1438 from Sari and 1361 from Kerman). The mean age was 33.7 years (range 18-66), with 1398 men. IgA anti-tissue transglutaminase (tTG) and IgA anti-EMA were determined in the serum of all subjects. Those participants with a positive serology for any of the two tests underwent small intestinal biopsy, and were classified according to revised Marsh criteria histologically. A diagnosis of GSE was based on positive serology and a compatible histopathological finding. The maximum likelihood latent class model was used to estimate the sensitivity and specificity of the two tests.
Twenty-nine cases showed positive IgA tTG-Ab (15 men and 14 women, mean age 35.4 years, range 18-59), whereas only five were simultaneously positive for EMA. Except for two subjects with normal small bowel histology (Marsh 0), all other subjects were found to have biopsy findings compatible with GSE: 18 Marsh I, five Marsh II, three Marsh IIIa and one Marsh IIIc lesions. he prevalence of GSE was 0.96% or 1:104. The sensitivity and specificity of the human-recombinant IgA tTG-Ab assay were 100 and 99%, respectively, whereas the results for IgA EMA were 19 and 100%, respectively. The IgA EMA was positive in cases with advanced mucosal lesions of the small bowel. The mean serum value of IgA tTG-Ab was higher in patients with severe enteropathy compared with those showing slight mucosal changes (P<0.05).
The minimum prevalence of gluten sensitivity among the general population of northern and southern Iran is 1:104. The best screening test for the detection of GSE in the general population is IgA tTG-Ab.
关于西亚国家乳糜泻（CD）患病率的基于人群的研究较少。我们旨在确定伊朗北部和南部普通人群中麸质敏感性肠病（GSE）的患病率，并评估抗肌内膜抗体（EMA）免疫荧光试验和基于酶联免疫吸附测定法、使用人重组转谷氨酰胺酶抗原检测IgA抗组织转谷氨酰胺酶抗体（tTG-Ab）的检测方法在无症状成年人群CD筛查中的敏感性和特异性。
采用分层随机抽样方法，我们共纳入了2799名个体（1438名来自萨里，1361名来自克尔曼）。平均年龄为33.7岁（范围18 - 66岁），其中男性1398名。测定了所有受试者血清中的IgA抗组织转谷氨酰胺酶（tTG）和IgA抗EMA。两项检测中任何一项血清学呈阳性的参与者均接受小肠活检，并根据修订的马什标准进行组织学分类。GSE的诊断基于血清学阳性和符合的组织病理学发现。使用最大似然潜在类别模型来估计两项检测的敏感性和特异性。
29例显示IgA tTG-Ab阳性（15名男性和14名女性，平均年龄35.4岁，范围18 - 59岁），而只有5例EMA同时呈阳性。除2名小肠组织学正常（马什0级）的受试者外，所有其他受试者的活检结果均与GSE相符：18例马什I级、5例马什II级、3例马什IIIa级和1例马什IIIc级病变。GSE的患病率为0.96%或1:104。人重组IgA tTG-Ab检测的敏感性和特异性分别为100%和99%，而IgA EMA的结果分别为19%和100%。IgA EMA在小肠黏膜病变晚期的病例中呈阳性。与黏膜轻度改变的患者相比，严重肠病患者的IgA tTG-Ab血清平均值更高（P<0.05）。
伊朗北部和南部普通人群中麸质敏感性的最低患病率为1:104。普通人群中检测GSE的最佳筛查试验是IgA tTG-Ab。
