检测猴食管和脐带中的IgA和IgG抗麦醇溶蛋白、IgA抗转谷氨酰胺酶及抗肌内膜抗体，用于发展中国家乳糜泻的诊断。

Determining IgA and IgG antigliadin, IgA antitransglutaminase, and antiendomysial antibodies in monkey esophagus and in umbilical cord for diagnosis of celiac disease in developing countries.

作者信息

Bahia Magda, Penna Francisco José, Sampaio Ivan Barbosa Machado, Silva Geraldo Magela Fritz, Andrade Eugênio Marcos Goulart

机构信息

Departments of Complementary Medicine, FM/UFMG, Avenida Alfredo Balena 190, s/6000, 30130-100, Belo Horizonte, Minas Gerais, Brazil.

出版信息

J Pediatr Gastroenterol Nutr. 2007 Nov;45(5):551-8. doi: 10.1097/MPG.0b013e31805fe9b0.

DOI:10.1097/MPG.0b013e31805fe9b0

PMID:18030232

Abstract

OBJECTIVES

To assess the efficiency of determining IgA and IgG antigliadin antibodies (IgA- and IgG-AGA, respectively), antitransglutaminase (TgA), and anti-endomysial antibodies (AEA) in human umbilical cord (CO) and monkey esophagus for diagnosis of celiac disease; to determine the correlation between serological markers and celiac disease.

PATIENTS AND METHODS

A total of 400 patients were divided in 3 groups: group 1 with 37 patients with celiac disease, group 2 with 208 patients with no enteropathies, and group 3 with 155 patients with other enteropathies. IgA-AGA, IgG-AGA, and TgA were assessed using enzyme-linked immunosorbent assay, whereas AEA was evaluated by indirect immunofluorescence.

RESULTS

Sensitivity and specificity of IgA-AGA were 81.1% and 95.2%, of IgG-AGA 89.2% and 95.2%, of TgA 83.9% and 96.8%, of AEA-CO 87.9% and 100%, and of AEA of monkey esophagus 88.6% and 100%, respectively. Positive predictive values were 75.0%, 76.7%, 83.9%, and 100%. Negative predictive values were 96.6%, 98.0%, 96.8%, and 97.7% for IgA-AGA, IgG-AGA, TgA, and AEA, respectively. Multivariate analysis showed a strong association between AEA-CO and celiac disease and a good correlation with other markers (TgA, IgA-AGA, and IgG-AGA).

CONCLUSIONS

TgA has been recommended for screening patients with celiac disease. Considering the similar sensitivity and specificity of IgA-AGA and TgA and their correlations in the multivariate analysis, both are applicable for this purpose. However, because TgA tests are highly costly and celiac disease is associated with IgA deficiency, the determination of IgA-AGA and IgG-AGA, followed by AEA-CO, is suitable for screening in developing countries, provided a cutoff point for these examinations is established. The results of antiendomysial antibodies in umbilical cord overlapped those in monkey esophagus. Therefore, umbilical cord should be used as a substrate instead of specimens from endangered species.

摘要

目的

评估检测人脐带血（CO）和猴食管中抗麦醇溶蛋白IgA和IgG抗体（分别为IgA-AGA和IgG-AGA）、抗转谷氨酰胺酶（TgA）和抗肌内膜抗体（AEA）用于诊断乳糜泻的效率；确定血清学标志物与乳糜泻之间的相关性。

患者与方法

总共400例患者分为3组：第1组37例乳糜泻患者，第2组208例无肠道疾病患者，第3组155例患有其他肠道疾病的患者。采用酶联免疫吸附测定法评估IgA-AGA、IgG-AGA和TgA，而通过间接免疫荧光法评估AEA。

结果

IgA-AGA的敏感性和特异性分别为81.1%和95.2%，IgG-AGA分别为89.2%和95.2%，TgA分别为83.9%和96.8%，脐带血AEA为87.9%和100%，猴食管AEA为88.6%和100%。阳性预测值分别为75.0%、76.7%、83.9%和100%。IgA-AGA、IgG-AGA、TgA和AEA的阴性预测值分别为96.6%、98.0%、96.8%和97.7%。多变量分析显示脐带血AEA与乳糜泻之间存在强关联，并且与其他标志物（TgA、IgA-AGA和IgG-AGA）具有良好的相关性。

结论

已推荐使用TgA对乳糜泻患者进行筛查。考虑到IgA-AGA和TgA在敏感性和特异性方面相似，且在多变量分析中具有相关性，二者均适用于此目的。然而，由于TgA检测成本高昂，且乳糜泻与IgA缺乏相关，因此在发展中国家，若能确定这些检测的临界值，先检测IgA-AGA和IgG-AGA，随后检测脐带血AEA，适合用于筛查。脐带血中抗肌内膜抗体的结果与猴食管中的结果重叠。因此，应使用脐带血作为检测底物，而非濒危物种的标本。