Papp Maria, Foldi Ildiko, Altorjay Istvan, Palyu Eszter, Udvardy Miklos, Tumpek Judit, Sipka Sandor, Korponay-Szabo Ilma Rita, Nemes Eva, Veres Gabor, Dinya Tamas, Tordai Attila, Andrikovics Hajnalka, Norman Gary L, Lakatos Peter Laszlo
2nd Department of Medicine, University of Debrecen, Nagyerdei krt. 98, Debrecen, H-4032, Hungary.
World J Gastroenterol. 2009 Aug 21;15(31):3891-900. doi: 10.3748/wjg.15.3891.
To determine the prevalence of a new set of anti-glycan and anti-outer membrane protein (anti-OMP) antibodies in a Hungarian cohort of adult Celiac disease (CD) patients.
190 consecutive CD patients [M/F: 71/119, age:39.9 (SD:14.1) years], 100 healthy, and 48 gastrointestinal controls were tested for glycan anti-Saccharomyces cerevisiae (gASCA), anti-laminaribioside (ALCA), anti-chitobioside, anti-mannobioside, anti-OMP antibodies and major NOD2/CARD15 mutations. Thirty out of 82 CD patients enrolled at the time of diagnosis were re-evaluated for the same antibodies after longstanding gluten-free diet (GFD).
65.9% of the CD patients were positive for at least one of the tested antibodies at the time of the diagnosis. Except anti-OMP and ALCA, anti-microbial antibodies were exclusively seen in untreated CD; however, the overall sensitivity was low. Any glycan positivity (LR+: 3.13; 95% CI: 2.08-4.73) was associated with an increased likelihood ratio for diagnosing CD. Significant correlation was found between the levels of anti-glycan and anti-endomysial or anti-transglutaminase antibodies. Anti-glycan positivity was lost after longstanding GFD. Anti-glycan antibody titers were associated with symptoms at presentation, but not the presence of NOD2/CARD15 mutations. Patients with severe malabsorption more frequently had multiple antibodies at diagnosis (P = 0.019).
The presence of anti-glycan antibodies in CD seems to be secondary to the impaired small bowel mucosa which can lead to increased antigen presentation. Furthermore, anti-glycan positivity may be considered an additional marker of CD and dietary adherence.
确定匈牙利成年乳糜泻（CD）患者队列中一组新的抗聚糖和抗外膜蛋白（抗OMP）抗体的患病率。
对190例连续的CD患者[男/女：71/119，年龄：39.9（标准差：14.1）岁]、100例健康对照者和48例胃肠道疾病对照者进行了抗酿酒酵母聚糖（gASCA）、抗层粘连二糖苷（ALCA）、抗壳二糖苷、抗甘露二糖苷、抗OMP抗体和主要NOD2/CARD15突变检测。在诊断时纳入的82例CD患者中，30例在长期无麸质饮食（GFD）后重新评估了相同的抗体。
65.9%的CD患者在诊断时至少有一种检测抗体呈阳性。除抗OMP和ALCA外，抗微生物抗体仅在未经治疗的CD患者中出现；然而，总体敏感性较低。任何聚糖阳性（似然比+：3.13；95%置信区间：2.08 - 4.73）与诊断CD的似然比增加相关。抗聚糖和抗肌内膜或抗转谷氨酰胺酶抗体水平之间存在显著相关性。长期GFD后抗聚糖阳性消失。抗聚糖抗体滴度与就诊时的症状相关，但与NOD2/CARD15突变的存在无关。严重吸收不良的患者在诊断时更频繁地出现多种抗体（P = 0.019）。
CD患者中抗聚糖抗体的存在似乎继发于小肠黏膜受损，这可能导致抗原呈递增加。此外，抗聚糖阳性可被视为CD和饮食依从性的一个额外标志物。
