Hans Christian Andersen Children's Hospital, Odense University Hospital, Denmark.
Clin Chem Lab Med. 2010 May;48(5):685-91. doi: 10.1515/CCLM.2010.136.
Celiac disease (CD) antibodies, immunoglobulin A (IgA) anti-tissue transglutaminase (anti-tTG), IgA endomysium antibody (EMA), IgA and IgG anti-gliadin antibodies (IgA and IgG AGA) are first-line diagnostic tools used in selecting patients for duodenal biopsy. The goal of this study was to evaluate the diagnostic quality of serological testing for CD.
CD serological tests (IgA and IgG AGA, anti-tTG and EMA) from 11,915 individuals were measured. Data were combined with clinical data and results of duodenal biopsy using a unique Danish personal identification number.
The positive predictive value (PPV) varied according to different combinations of positive CD antibodies, being highest when all antibodies were positive (97.6%). The anti-tTG concentration correlated strongly with EMA positivity, number of additional positive antibodies, and higher PPV. A logistic regression model predicted the probability of later biopsy-proven CD in relation to concentrations of IgA AGA and anti-tTG at initial serological screening.
The anti-tTG concentration at initial serological CD screening was highly informative in relation to EMA positivity, number of additional CD specific antibodies and PPV. Furthermore, in the high-risk group of patients investigated, the concentrations of anti-tTG and IgA AGA at initial serological screening could accurately predict the probability of future biopsy-proven CD.
乳糜泻（CD）抗体，免疫球蛋白 A（IgA）抗组织转谷氨酰胺酶（抗-tTG）、IgA 内膜抗体（EMA）、IgA 和 IgG 抗麦胶蛋白抗体（IgA 和 IgG AGA）是用于选择进行十二指肠活检的患者的一线诊断工具。本研究的目的是评估 CD 血清学检测的诊断质量。
测量了 11915 个人的 CD 血清学检测（IgA 和 IgG AGA、抗-tTG 和 EMA）。数据与临床数据和十二指肠活检结果使用独特的丹麦个人识别号码相结合。
阳性预测值（PPV）根据不同的阳性 CD 抗体组合而有所不同，当所有抗体均为阳性时，PPV 最高（97.6%）。抗-tTG 浓度与 EMA 阳性、额外阳性抗体数量以及更高的 PPV密切相关。逻辑回归模型预测了与初始血清学筛查时 IgA AGA 和抗-tTG 浓度相关的后续活检证实 CD 的概率。
在初始血清学 CD 筛查中，抗-tTG 浓度与 EMA 阳性、额外的 CD 特异性抗体数量和 PPV 高度相关。此外，在研究的高风险患者组中，初始血清学筛查时抗-tTG 和 IgA AGA 的浓度可以准确预测未来活检证实 CD 的概率。
