Department of Dermatology, University of Lübeck, Lübeck, Germany.
J Am Acad Dermatol. 2012 Apr;66(4):583-8. doi: 10.1016/j.jaad.2011.02.025. Epub 2011 Aug 12.
Dermatitis herpetiformis (DH) is a cutaneous manifestation of celiac disease (CD), the latter being identified by circulating autoantibodies against native gliadin (nGli), tissue transglutaminase (tTG), endomysium, or a combination of these. Recently, a novel serologic assay using deamidated gliadin-analogous fusion peptides (GAF3X) showed high diagnostic sensitivity in patients with CD.
The aim of this study was to explore the anti-GAF3X enzyme-linked immunosorbent assay (ELISA) and to compare it with a panel of classic CD-related serologic tests in patients with DH.
Antibodies against nGli, GAF3X, and tTG were determined by separate ELISA tests and against endomysium by indirect immunofluorescence microscopy in 45 patients with DH and 52 control patients (30 patients with bullous pemphigoid and 22 patients with linear IgA disease). A total of 24 patients with DH underwent intestinal biopsies to confirm underlying CD.
Antibodies to nGli were detected in 26 (58%) (IgA) and 24 (53%) (IgG), to GAF3X in 38 (84%) (IgA) and 36 (80%) (IgG), to tTG in 35 (78%) (IgA), and to endomysium in 32 (71%) (IgA) patients with DH. Combined testing of IgA and IgG antibodies to GAF3X detected 7 of 10 (70%) IgA-anti-tTG-negative patients with DH and together with the IgA-anti-tTG ELISA showed the highest serologic hit rate (93%) for CD.
Intestinal biopsies were not performed in all patients with DH.
The novel anti-GAF3X ELISA shows a higher sensitivity to detect CD-associated autoantibodies in patients with DH compared with tests using nGli, tTG, or endomysium as substrates.
疱疹样皮炎（DH）是乳糜泻（CD）的皮肤表现，后者通过针对天然麦胶（nGli）、组织转谷氨酰胺酶（tTG）、内肌层或这些物质的组合的循环自身抗体来确定。最近，一种使用脱酰胺麦胶类似融合肽（GAF3X）的新型血清学检测方法在 CD 患者中显示出较高的诊断敏感性。
本研究旨在探索抗-GAF3X 酶联免疫吸附试验（ELISA），并将其与一组经典的 CD 相关血清学检测方法在 DH 患者中的应用进行比较。
在 45 例 DH 患者和 52 例对照患者（30 例大疱性类天疱疮患者和 22 例线性 IgA 疾病患者）中，通过单独的 ELISA 试验分别测定 nGli、GAF3X 和 tTG 抗体，并通过间接免疫荧光显微镜测定针对内肌层的抗体。共有 24 例 DH 患者接受了肠道活检以确认潜在的 CD。
26 例（58%）（IgA）和 24 例（53%）（IgG）DH 患者检测到 nGli 抗体，38 例（84%）（IgA）和 36 例（80%）（IgG）DH 患者检测到 GAF3X 抗体，35 例（78%）（IgA）DH 患者检测到 tTG 抗体，32 例（71%）（IgA）DH 患者检测到内肌层抗体。联合检测 IgA 和 IgG 抗-GAF3X 抗体检测到 10 例（70%）DH 患者中 IgA-抗-tTG 阴性患者中的 7 例，与 IgA-抗-tTG ELISA 联合使用时，对 CD 的血清学检出率最高（93%）。
并非所有 DH 患者均进行了肠道活检。
与使用 nGli、tTG 或内肌层作为底物的检测方法相比，新型抗-GAF3X ELISA 检测 DH 患者 CD 相关自身抗体的敏感性更高。
