Department of Clinical Medicine, University of Bologna, Bologna, Italy.
J Clin Gastroenterol. 2010 Mar;44(3):186-90. doi: 10.1097/MCG.0b013e3181c378f6.
This study was designed to establish whether deamidated gliadin peptide antibodies (DGP-AGA) could improve the serologic workup for celiac disease (CD).
The best serologic approach for CD screening is currently based on the combined detection of tissue transglutaminase (tTGA), endomysial (EmA), and gliadin antibodies (AGA).
One hundred forty-four consecutive patients with gastrointestinal and extraintestinal signs suggestive for CD were investigated using serologic tests, that is, IgG and IgA DGP-AGA, IgA tTGA, IgA EmA, and duodenal biopsy.
Forty-eight out of 144 patients (33%) had CD with different severity of villous atrophy. IgA tTGA showed 93.7% sensitivity compared with 91.6% for IgA EmA, 84.3% for IgA DGP-AGA, and 82.3% for IgG DGP-AGA. Of the 3 cases negative for IgA tTGA, IgA EmA, and IgA DGP-AGA, 2 had total IgA deficiency, although both were positive for IgG DGP-AGA. IgG DGP-AGA showed a very high specificity for CD (98.9%), not only superior to IgA DGP-AGA (79.8%), but also to IgA tTGA (96.6%) and very close to IgA EmA (100%).
Our prospective study shows that the combined search for IgA tTGA and IgG DGP-AGA provides the best diagnostic accuracy for CD, allowing the identification of all CD cases---except one---with a very high specificity. The serologic workup for CD screening could be significantly improved by the routine introduction of IgG DGP-AGA together with IgA tTGA, thus reducing the number of tests and with an obvious advantage in terms of cost-efficacy.
本研究旨在确定脱酰胺麦胶肽抗体（DGP-AGA）是否能提高对乳糜泻（CD）的血清学检查。
目前，CD 筛查的最佳血清学方法是基于组织转谷氨酰胺酶（tTGA）、内肌内膜（EmA）和麦胶蛋白抗体（AGA）的联合检测。
对 144 例有胃肠道和肠外表现的疑似 CD 患者进行了血清学检测，包括 IgG 和 IgA DGP-AGA、IgA tTGA、IgA EmA 和十二指肠活检。
144 例患者中，48 例（33%）有不同程度的绒毛萎缩，诊断为 CD。IgA tTGA 的敏感性为 93.7%，与 IgA EmA（91.6%）、IgA DGP-AGA（84.3%）和 IgG DGP-AGA（82.3%）相似。在 3 例 IgA tTGA、IgA EmA 和 IgA DGP-AGA 均阴性的患者中，2 例存在总 IgA 缺乏症，但均为 IgG DGP-AGA 阳性。IgG DGP-AGA 对 CD 的特异性非常高（98.9%），不仅优于 IgA DGP-AGA（79.8%），也优于 IgA tTGA（96.6%），与 IgA EmA（100%）非常接近。
我们的前瞻性研究表明，联合检测 IgA tTGA 和 IgG DGP-AGA 可提高对 CD 的诊断准确性，能发现所有的 CD 病例，除 1 例外均具有很高的特异性。常规引入 IgG DGP-AGA 与 IgA tTGA 联合检测，可显著改善 CD 的血清学筛查，减少检测次数，在成本效益方面具有明显优势。
