Bürgin-Wolff A, Gaze H, Hadziselimovic F, Huber H, Lentze M J, Nusslé D, Reymond-Berthet C
Department of Microbiology and Immunology, University Children's Hospital, Basel, Switzerland.
Arch Dis Child. 1991 Aug;66(8):941-7. doi: 10.1136/adc.66.8.941.
The value of IgG and IgA gliadin antibodies (AGA) was compared with that of IgA endomysium antibodies (EMA) for the diagnosis of coeliac disease. Three hundred and six of 340 (90%) children with untreated coeliac disease (flat mucosa) had EMA and 338/340 (99.4%) had IgG AGA and/or IgA AGA. Only 1/340 (a 7 year old boy with selective IgA deficiency) had neither AGA nor EMA. Absence of EMA is more frequent in coeliac patients younger than 2 years than in older patients (32/277 compared with 1/62). EMA were present in 4/211 (2%) of comparison subjects (normal mucosa), IgA AGA in 12/211 (6%), and IgG AGA in 74/211 (35%). The specificity of AGA cannot be calculated from these figures as they are biased. The combined determination of AGA and EMA, taking advantage of the high sensitivity of AGA and the high specificity of EMA, gives an excellent prediction of the condition of the mucosa: 247/248 patients (99.6%) with positive EMA and positive IgG AGA and IgA AGA had a flat mucosa, whereas 136/137 patients (99.3%) with neither AGA nor EMA had a normal mucosa. During a gluten free diet EMA and AGA disappear. Their presence or absence is therefore an indicator of dietary compliance. After reintroduction of gluten into the diet 110/134 (82%) of the patients who had a flat mucosa at diagnosis relapsed, but 24/134 still had a normal mucosa after 2-15 years of challenge. All these patients without a morphological relapse were less than 2 years old at diagnosis so we conclude that patients who are young at diagnosis should be challenged. AGA often reappear earlier than EMA. After one month of challenge 93% of patients are AGA and 69% EMA positive. After more than three years of gluten intake the percentage of AGA positive patients decreased to about 50% whereas the percentage of EMA positive sera was then highest (93%). Therefore EMA are more sensitive for the detection of 'silent' relapse after prolonged periods of gluten intake.
将IgG和IgA麦醇溶蛋白抗体（AGA）的值与IgA肌内膜抗体（EMA）的值进行比较，以诊断乳糜泻。340例未经治疗的乳糜泻（黏膜扁平）患儿中，306例（90%）有EMA，338/340例（99.4%）有IgG AGA和/或IgA AGA。仅1/340例（一名7岁选择性IgA缺乏男孩）既无AGA也无EMA。2岁以下的乳糜泻患者中EMA缺失比年龄较大的患者更常见（32/277例与1/62例相比）。211例对照受试者（正常黏膜）中，4例（2%）有EMA，12例（6%）有IgA AGA，74例（35%）有IgG AGA。由于这些数据存在偏差，无法据此计算AGA的特异性。联合检测AGA和EMA，利用AGA的高敏感性和EMA的高特异性，能很好地预测黏膜状况：248例EMA阳性且IgG AGA和IgA AGA阳性的患者中，247例（99.6%）黏膜扁平，而137例既无AGA也无EMA的患者中，136例（99.3%）黏膜正常。在无麸质饮食期间，EMA和AGA消失。因此，它们的存在与否是饮食依从性的指标。重新引入麸质饮食后，诊断时黏膜扁平的患者中，110/134例（82%）复发，但24/134例在接受2至15年的激发试验后仍有正常黏膜。所有这些无形态学复发的患者诊断时年龄均小于2岁，因此我们得出结论，诊断时年龄较小的患者应接受激发试验。AGA通常比EMA更早重新出现。激发试验1个月后，93%的患者AGA阳性，69%的患者EMA阳性。摄入麸质超过三年后，AGA阳性患者的百分比降至约50%，而此时EMA阳性血清的百分比最高（93%）。因此，EMA对长期摄入麸质后“隐匿性”复发的检测更敏感。
