Utiyama Shirley Ramos da Rosa, Nass Flávia Raphaela, Kotze Lorete Maria da Silva, Nisihara Renato Mitsunori, Ambrosio Altair Rogério, Messias-Reason Iara Taborda de
Laboratório de Imunopatologia, Hospital de Clínicas, Universidade Federal do Paraná, Curatiba, PR.
Arq Gastroenterol. 2007 Apr-Jun;44(2):156-61. doi: 10.1590/s0004-28032007000200014.
Celiac disease is the most common intestinal disorder of caucasian populations and presents a prevalence of 8% to 18% between the relatives of patients. The anti-endomysial (IgA-EmA) and anti-tissue transglutaminase antibodies (IgA-tTG) have represented an important non invasive and sensitivity method of screening and diagnosis of celiac disease in risk groups and populations.
To investigate the prevalence of IgA-EmA and IgA-tTG antibodies in relatives of celiac patients and verify the degree of concordance between them.
One hundred and seventy seven relatives of celiac patients (76(feminino); 101(masculino); 2-79 years) and 93 healthy individuals were evaluated (34(feminino); 59(masculino); 2-71 years). IgA-EmA were detected by indirect immunofluorescence, with human umbilical cord as substrate, while anti-IgA-tTG titers were measured by enzyme-linked immunosorbent assay (ELISA), using commercial kit.
Total positivity to antibodies in relatives of celiac patients was of 21% (37/177), and showed significant difference compared to control group (0%; 0/93). Twelve percent (21/177) of celiac disease relatives were positive to IgA-EmA, 13.56% (24/177) to IgA-tTG, and 4.52% (8/177) to both assays simultaneously. The concordance between both methods was 83.6% (148/177) and the discordance was 16.4% (29/177), with a positive and significant correlation (r = 0.435). Among the concordant results, 79.1% (140/177) were negative and 4.52% (8/177) were positive to both antibodies. Among the discordant results, 7.34% (13/177) were positive to IgA-EmA and negative to IgA-tTG, while 9.04% (16/177) were negative to IgA- EmA and positive to IgA-tTG.
Although the high positivity to IgA-EmA and IgA-tTG emphasizes the importance of the serological screening in relatives of celiac patients, the discordances detected in this study showed that the use of only one method can lead to false negative results. Consequently these relatives will not be submitted to intestinal biopsy to confirm the diagnosis of celiac disease, and to the correct and earlier treatment.
乳糜泻是白种人群中最常见的肠道疾病，在患者亲属中的患病率为8%至18%。抗肌内膜（IgA-EmA）和抗组织转谷氨酰胺酶抗体（IgA-tTG）是筛查和诊断高危人群及普通人群乳糜泻的重要非侵入性敏感方法。
调查乳糜泻患者亲属中IgA-EmA和IgA-tTG抗体的患病率，并验证两者之间的一致性程度。
对177名乳糜泻患者的亲属（76名女性；101名男性；年龄2至79岁）和93名健康个体（34名女性；59名男性；年龄2至71岁）进行评估。以人脐带为底物，通过间接免疫荧光法检测IgA-EmA，使用商业试剂盒通过酶联免疫吸附测定（ELISA）法检测抗IgA-tTG滴度。
乳糜泻患者亲属中抗体总阳性率为21%（37/177），与对照组（0%；0/93）相比有显著差异。12%（21/177）的乳糜泻患者亲属IgA-EmA呈阳性，13.56%（24/177）的IgA-tTG呈阳性，4.52%（8/177）的两种检测均呈阳性。两种方法之间的一致性为83.6%（148/177），不一致性为16.4%（29/177），呈显著正相关（r = 0.435）。在一致的结果中，79.1%（140/177）两种抗体均为阴性，4.52%（8/177）两种抗体均为阳性。在不一致的结果中，7.34%（13/177）的IgA-EmA呈阳性而IgA-tTG呈阴性，9.04%（16/177）的IgA-EmA呈阴性而IgA-tTG呈阳性。
尽管IgA-EmA和IgA-tTG的高阳性率强调了对乳糜泻患者亲属进行血清学筛查的重要性，但本研究中检测到的不一致性表明仅使用一种方法可能会导致假阴性结果。因此，这些亲属将不会接受肠道活检以确诊乳糜泻，也无法得到正确且早期的治疗。
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