Vécsei A K, Graf U B, Vogelsang H
St. Anna Children's Hospital, Vienna, Austria.
Endoscopy. 2009 Feb;41(2):123-8. doi: 10.1055/s-0028-1103484. Epub 2009 Feb 12.
SPECIFIC AUTHOR CONTRIBUTIONS: Andreas Vécsei, MD, and Ulrike Graf wrote the manuscript. All authors contributed to study design, data collection and analysis, and approved the final draft for submission. The corresponding author declares that the manuscript is submitted on behalf of all authors.
The best mode of follow-up in celiac disease has not yet been established. The intention of this study was to clarify which noninvasive follow-up investigation - serological tests or intestinal permeability test (IPT) - correlates best with histology and whether the interval between diagnosis and follow-up affects the accuracy of these tests.
Data from adult patients with celiac disease (diagnosed between December 1989 and July 2006) followed up with biopsy, IPT, and serological tests [IgG anti-gliadin antibodies (AGA-IgG), AGA-IgA, and endomysial antibodies (EMA)] were retrieved from a computerized database. Results of noninvasive tests were compared with the persistence of villous atrophy on biopsy. Patients were divided into groups A, which comprised patients followed up within 2 years after diagnosis, and B, comprising patients followed up later than 2 years.
Forty-seven patients were evaluable. The lactulose/mannitol (L/M) ratio had a sensitivity of 85 % and a specificity of 46.2 % for mucosal atrophy, whereas saccharose excretion showed a sensitivity of 60 % and a specificity of 52.6 %. The sensitivities of AGA-IgA and AGA-IgG were 15 % and 20 %, respectively, while specificity was 100 % for both. Validity of AGA was limited due to low number of positive results. EMA assay was 50 % sensitive and 77.8 % specific. In group A (n = 23) L/M ratio performed best in terms of sensitivity (88.9 %), whereas EMA achieved a higher specificity (71.4 %). In group B, the sensitivity of the L/M ratio decreased to 85.7 %, while the specificity of EMA increased to 91.7 %.
In this study, none of the noninvasive tests was an accurate substitute for follow-up biopsy in detecting severe mucosal damage.
医学博士安德里亚斯·韦克塞伊和乌尔里克·格拉夫撰写了本文。所有作者都参与了研究设计、数据收集与分析，并批准了提交的最终稿件。通讯作者声明本文是代表所有作者提交的。
乳糜泻的最佳随访模式尚未确定。本研究旨在明确哪种非侵入性随访检查——血清学检测或肠道通透性检测（IPT）——与组织学结果相关性最佳，以及诊断与随访之间的间隔是否会影响这些检测的准确性。
从计算机数据库中检索了1989年12月至2006年7月期间诊断为乳糜泻的成年患者的数据，这些患者接受了活检、IPT和血清学检测[抗麦醇溶蛋白IgG抗体（AGA-IgG）、AGA-IgA和肌内膜抗体（EMA）]。将非侵入性检测结果与活检时绒毛萎缩的持续情况进行比较。患者分为A组（诊断后2年内接受随访的患者）和B组（诊断后2年以上接受随访的患者）。
47例患者可进行评估。乳果糖/甘露醇（L/M）比值对黏膜萎缩的敏感性为85%，特异性为46.2%，而蔗糖排泄的敏感性为60%，特异性为52.6%。AGA-IgA和AGA-IgG的敏感性分别为15%和20%，两者的特异性均为100%。由于阳性结果数量较少，AGA的有效性有限。EMA检测的敏感性为50%，特异性为77.8%。在A组（n = 23）中，L/M比值在敏感性方面表现最佳（88.9%），而EMA具有更高的特异性（71.4%）。在B组中，L/M比值的敏感性降至85.7%，而EMA的特异性升至91.7%。
在本研究中，在检测严重黏膜损伤方面，没有一种非侵入性检测能准确替代随访活检。
