Department of Internal Medicine, Ospedali Civili Riuniti, Sciacca AG, Italy.
Eur J Gastroenterol Hepatol. 2011 Nov;23(11):1018-23. doi: 10.1097/MEG.0b013e328349b8a5.
Celiac disease (CD) diagnosis is becoming more difficult as patients with no intestinal histology lesions may also be suffering from CD.
To evaluate the diagnostic accuracy of antiendomysium (EmA) assay in the culture medium of intestinal biopsies for CD diagnosis.
The clinical charts of 418 patients with CD and 705 non-CD controls who had all undergone EmA assay in the culture medium were reviewed.
EmA assay in the culture medium had a higher sensitivity (98 vs. 80%) and specificity (99 vs. 95%) than serum EmA/antibodies to tissue transglutaminase (anti-tTG) assay. All patients with CD who were tested as false-negatives for serum EmA and/or anti-tTG (32 adults and 39 children) carried the human leukocyte antigen alleles associated to CD. Furthermore, during the follow-up, four patients with negative-serum EmA/anti-tTG, normal villi architecture, and positive-EmAs in the culture medium, developed villous atrophy and underwent gluten-free diet with consequent resolution of the symptoms and complete intestinal histology recovery.
EmA assay in the culture medium should be included in the diagnostic criteria for CD diagnosis in 'seronegative' patients.
由于无肠道组织学病变的患者也可能患有乳糜泻（CD），因此 CD 的诊断变得更加困难。
评估肠活检培养物中抗内膜（EmA）检测在 CD 诊断中的诊断准确性。
回顾了 418 例 CD 患者和 705 例非 CD 对照者的临床病历，所有患者均进行了肠活检培养物 EmA 检测。
肠活检培养物 EmA 检测的敏感性（98%比 80%）和特异性（99%比 95%）均高于血清 EmA/组织转谷氨酰胺酶抗体（抗-tTG）检测。所有血清 EmA 和/或抗-tTG 检测呈阴性的 CD 患者（32 名成人和 39 名儿童）均携带与 CD 相关的人类白细胞抗原等位基因。此外，在随访期间，4 名血清 EmA/抗-tTG 阴性、绒毛结构正常、肠活检培养物 EmA 阳性的患者出现绒毛萎缩，并接受无麸质饮食治疗，随后症状缓解，肠道组织学完全恢复。
在“血清阴性”患者的 CD 诊断标准中应纳入肠活检培养物 EmA 检测。
