Department of Pediatric Gastroenterology, Leiden University Medical Centre, Leiden, Netherlands.
Pediatrics. 2011 Sep;128(3):547-52. doi: 10.1542/peds.2010-3762. Epub 2011 Aug 22.
Celiac disease (CD) is characterized by histologic alterations in small bowel biopsies. Circulating specific CD antibodies at the time of diagnosis and their disappearance after a gluten-free diet support the diagnosis of CD. We aimed to determine the behavior of the CD antibodies immunoglobulin A anti-tissue transglutaminase (anti-TG2) and immunoglobulin A endomysium (EMA) in children with CD after starting a gluten-free diet.
This was a retrospective multicenter study in the Netherlands between 2001 and 2009. Inclusion criteria were all newly diagnosed patients with CD younger than 19 years who had at least 1 anti-TG2 and/or EMA measurement before and after starting a gluten-free diet. Eight different anti-TG2 kits were used with substrates of guinea pig TG2 in 1 (Sigma) and 7 human-recombinant TG2: Varelisa and EliA Celikey Phadia-GmbH; Orgentec Diagnostica-GmbH; Diarect AG; Roboscreen GmbH; Aeskulisa Diagnostics; Binding Site Ltd. EMA was analyzed with indirect immunofluorescence tests. Statistical analyses were performed by using mixed-model repeated measurements and survival analysis.
There were 129 children with CD included (mean age: 5.6 years; SD ± 4.2). The mean concentration of anti-TG2 decreased significantly within 3 months after starting a gluten-free diet (P < .0001). The cumulative percentage of children who became negative for EMA after ½, 1, 1½, and 2 years was 31%, 60%, 74%, and 87%, respectively. For anti-TG2, a comparable trend was shown: 35%, 55%, 64%, and 78%, respectively.
Doctors taking care of children with CD should be aware that the mean concentration of anti-TG2 will show a 74% decrease (95% confidence interval: 69%-79%) after 3 months of gluten-free diet, and ∼80% of the children will be sero-negative for EMA and anti-TG2 after 2 years of the diet.
乳糜泻（CD）的特征是小肠活检的组织学改变。在诊断时循环中的特定 CD 抗体及其在无麸质饮食后的消失支持 CD 的诊断。我们旨在确定 CD 抗体免疫球蛋白 A 抗组织转谷氨酰胺酶（抗 TG2）和免疫球蛋白 A 内肌层（EMA）在开始无麸质饮食后儿童中的行为。
这是 2001 年至 2009 年在荷兰进行的一项回顾性多中心研究。纳入标准为所有新诊断的年龄小于 19 岁的 CD 患者，他们在开始无麸质饮食前后至少有 1 次抗 TG2 和/或 EMA 测量。使用了 8 种不同的抗 TG2 试剂盒，其中 1 种（Sigma）和 7 种人重组 TG2 的底物为豚鼠 TG2：Varelisa 和 EliA Celikey Phadia-GmbH；Orgentec Diagnostica-GmbH；Diarect AG；Roboscreen GmbH；Aeskulisa Diagnostics；Binding Site Ltd. EMA 用间接免疫荧光试验分析。使用混合模型重复测量和生存分析进行统计分析。
共有 129 例 CD 患儿纳入（平均年龄：5.6 岁；标准差 ± 4.2）。无麸质饮食开始后 3 个月内，抗 TG2 的浓度显著降低（P<0.0001）。无麸质饮食后 1/2、1、1.5 和 2 年时，EMA 转为阴性的患儿百分比分别为 31%、60%、74%和 87%。对于抗 TG2，也显示出类似的趋势：35%、55%、64%和 78%。
照顾 CD 患儿的医生应该意识到，无麸质饮食 3 个月后，抗 TG2 的平均浓度将下降 74%（95%置信区间：69%-79%），并且无麸质饮食 2 年后，约 80%的患儿将 EMA 和抗 TG2 转为阴性。
