Diamanti Antonella, Colistro Franco, Calce Angelica, Devito Rita, Ferretti Francesca, Minozzi Antonio, Santoni Alexandra, Castro Massimo
Gastroenterology and Nutrition Unit, Pediatric Hospital Bambino Gesù, Piazza S Onofrio, 4 00165 Rome, Italy.
Pediatrics. 2006 Dec;118(6):e1696-700. doi: 10.1542/peds.2006-0604. Epub 2006 Oct 30.
Our goal was to evaluate the possible correspondence between antitissue transglutaminase of immunoglobulin A class levels and stage of mucosal damage in patients affected by celiac disease. In addition, we assessed clinical use of antitissue transglutaminase values to predict biopsy results.
One thousand eight hundred eighty-six consecutive patients with symptoms suggestive of celiac disease and 305 healthy controls underwent determination of serum levels of immunoglobulin A and antitissue transglutaminase. An intestinal biopsy was performed in subjects with antitissue transglutaminase levels > or = 4 IU/mL and in subjects with negative antitissue transglutaminase levels but with clinical suspicion of celiac disease. Histologic grading of celiac disease was consistent with the Marsh classification.
One hundred eighty-six subjects with positive antitissue transglutaminase levels and 91 patients with negative antitissue transglutaminase levels were submitted to biopsy. In all healthy subjects, antitissue transglutaminase results were negative. Histologic evaluations in patients with positive antitissue transglutaminase levels gave the following results: type 0 in 25 patients, type 1 in 3 patients, type 2 in 4 patients, type 3a in 22 patients, type 3b in 74 patients, and type 3c in 58 patients. None of the patients with negative antitissue transglutaminase levels showed histologic findings suggestive of celiac disease. The mean antitissue transglutaminase values in patients without mucosal atrophy were significantly lower than in patients with mucosal atrophy. Antitissue transglutaminase values > or = 20 IU/mL were found in only 1 patient without mucosal atrophy.
Our study found a strong correspondence between antitissue transglutaminase levels and stage of mucosal injury; antitissue transglutaminase values > 20 IU/mL seemed to be strongly predictive of mucosal atrophy.
我们的目标是评估患有乳糜泻的患者中免疫球蛋白A类抗组织转谷氨酰胺酶水平与黏膜损伤阶段之间可能存在的对应关系。此外，我们评估了抗组织转谷氨酰胺酶值在预测活检结果方面的临床应用。
1886例有乳糜泻症状的连续患者和305例健康对照者接受了血清免疫球蛋白A和抗组织转谷氨酰胺酶水平的测定。对抗组织转谷氨酰胺酶水平≥4 IU/mL的受试者以及抗组织转谷氨酰胺酶水平阴性但临床怀疑患有乳糜泻的受试者进行了肠道活检。乳糜泻的组织学分级与马什分类法一致。
186例抗组织转谷氨酰胺酶水平阳性的受试者和91例抗组织转谷氨酰胺酶水平阴性的患者接受了活检。所有健康受试者的抗组织转谷氨酰胺酶结果均为阴性。抗组织转谷氨酰胺酶水平阳性患者的组织学评估结果如下：0型25例，1型3例，2型4例，3a型22例，3b型74例，3c型58例。抗组织转谷氨酰胺酶水平阴性的患者均未表现出提示乳糜泻的组织学发现。无黏膜萎缩患者的平均抗组织转谷氨酰胺酶值显著低于有黏膜萎缩的患者。仅1例无黏膜萎缩的患者抗组织转谷氨酰胺酶值≥20 IU/mL。
我们的研究发现抗组织转谷氨酰胺酶水平与黏膜损伤阶段之间存在密切对应关系；抗组织转谷氨酰胺酶值>20 IU/mL似乎强烈预示着黏膜萎缩。
