Laboratory of Immunopathology, Clinical Hospital, Federal University of Paraná, Curitiba, Brazil.
Digestion. 2011;83(1-2):89-95. doi: 10.1159/000320451. Epub 2010 Oct 30.
BACKGROUND/AIMS: In this study, a clinical and serological follow-up of 8-10 years was performed in relatives of celiac disease (CD) patients from southern Brazil. The occurrence of new CD cases in the families and the use of two different IgA-tTG enzyme-linked immunosorbent assay (ELISA) kits were also evaluated.
Serum samples of 233 relatives, 186 recruited between 1997 and 2000 (phase I) and 138 between 2006 and 2007 (phase II: 91 of the follow-up group and 47 newly tested), were analyzed. As a comparison group, 100 unrelated healthy individuals were evaluated. IgA-EmA was tested by indirect immunofluorescence and IgA-tTG by ELISA.
A significant increase in IgA-EmA/IgA-tTG was detected in relatives of patients with CD when compared to controls (p ≤ 0.001). The positivity of antibodies was higher in females (2.4:1 in phase II; p = 0.039), and its high frequency amongst siblings (∼18.81%) highlights the risk of CD in these individuals. The distribution of antibodies by age suggested that CD can occur at any age in relatives, calling attention to the newly tested relatives >60 years of age (p = 0.0657). A better performance of ELISA kits with human tTG was observed. The confirmation of 13 biopsy-proven new CD cases (5.6%; 13/233) at present points out the predisposition to CD in these individuals and the high specificity of concurrently positive antibodies in relatives, especially when both are present in high titers.
These results emphasize the familial risk to develop CD and the value of serological screening as an instrument for identifying this disease.
背景/目的：本研究对来自巴西南部的乳糜泻（CD）患者亲属进行了 8-10 年的临床和血清学随访。还评估了家族中新发 CD 病例的发生情况以及使用两种不同的 IgA-tTG 酶联免疫吸附试验（ELISA）试剂盒。
分析了 233 名亲属的血清样本，其中 186 名于 1997 年至 2000 年（第 I 期）招募，138 名于 2006 年至 2007 年（第 II 期：91 名随访组和 47 名新检测组）招募。作为对照组，评估了 100 名无关的健康个体。通过间接免疫荧光法检测 IgA-EmA，通过 ELISA 检测 IgA-tTG。
与对照组相比，CD 患者亲属的 IgA-EmA/IgA-tTG 显著增加（p≤0.001）。女性抗体阳性率较高（第 II 期为 2.4:1；p=0.039），兄弟姐妹的高阳性率（约 18.81%）突出了这些个体患 CD 的风险。按年龄分布的抗体表明，CD 可在亲属中的任何年龄发生，值得注意的是新检测的 60 岁以上亲属（p=0.0657）。用人 tTG 进行 ELISA 试剂盒的性能更好。目前已确认 13 例活检证实的新 CD 病例（5.6%；13/233），这些个体存在发生 CD 的倾向，同时阳性抗体在亲属中具有高度特异性，尤其是当两种抗体均存在高滴度时。
这些结果强调了发生 CD 的家族风险，以及血清学筛查作为识别该疾病的工具的价值。
