测定针对天然麦胶蛋白的 IgG 和 IgA 抗体对于 2 岁以下儿童乳糜泻的诊断并无帮助。
Determination of IgG and IgA antibodies against native gliadin is not helpful for the diagnosis of coeliac disease in children up to 2 years old.
机构信息
Children's Hospital of the Clinical Centre, Sankt Georg, Leipzig, Germany.
出版信息
J Pediatr Gastroenterol Nutr. 2012 Jul;55(1):21-5. doi: 10.1097/MPG.0b013e31824678fc.
OBJECTIVE
Assays for antibodies against native gliadin (anti-nGli) are still often assumed to perform better in the diagnosis of coeliac disease in young children than tests for antibodies to deamidated gliadin (anti-dGli), tissue transglutaminase (anti-tTG), and endomysium (EmA). We compared the performance of assays for anti-nGli, anti-dGli, anti-tTG, and EmA in this age group.
METHODS
We investigated retrospectively 184 children (42 with coeliac disease under normal diet and 142 controls) up to 2 years of age. Immunoglobulin (Ig) A- and IgG-anti-dGli, IgA- and IgG-anti-nGli, IgA- and IgG-anti-tTG, and IgA-EmA were measured in serum. Areas under receiver operating characteristics curves, sensitivities, specificities, positive and negative predictive values, positive and negative likelihood ratios, as well as diagnostic odds ratios were calculated.
RESULTS
From all of the tests investigated, only assays for IgG-anti-dGli, IgA-anti-tTG, and IgA-EmA had high specificity (≥ 0.96) connected with high sensitivity (≥ 0.86), with high positive predictive values (≥ 0.52 and ≥ 0.69 at pretest probabilities of 0.05 and 0.1, respectively) and negative predictive values (≥ 0.99 and ≥ 0.98 at pretest probabilities of 0.05 and 0.1, respectively). These assays also showed high positive likelihood ratio (≥ 24) at low negative likelihood ratio (≤ 0.15) and high diagnostic odds ratios (≥ 136).
CONCLUSIONS
Our results do not support the use of assays of anti-nGli to diagnose coeliac disease in young children. IgA-anti-tTG, IgA-EmA, and IgG-anti-dGli perform better than anti-nGli.
目的
针对天然麦胶蛋白（anti-nGli）的抗体检测在诊断幼儿乳糜泻中的表现，仍常被认为优于针对脱酰胺麦胶蛋白（anti-dGli）、组织转谷氨酰胺酶（anti-tTG）和内肌层（EmA）的抗体检测。我们比较了这一年龄组中检测 anti-nGli、anti-dGli、anti-tTG 和 EmA 的性能。
方法
我们回顾性调查了 184 名年龄在 2 岁以下的儿童（42 名乳糜泻患儿在正常饮食下，142 名对照）。检测血清中的 IgA 和 IgG 型抗-dGli、IgA 和 IgG 型抗-nGli、IgA 和 IgG 型抗-tTG、以及 IgA-EmA。计算曲线下面积、敏感度、特异度、阳性和阴性预测值、阳性和阴性似然比以及诊断比值比。
结果
在所研究的所有检测中，只有 IgG-anti-dGli、IgA-anti-tTG 和 IgA-EmA 的特异性（≥0.96）高，同时敏感度（≥0.86）也高，阳性预测值（在预检测概率为 0.05 和 0.1 时，分别≥0.52 和≥0.69）和阴性预测值（在预检测概率为 0.05 和 0.1 时，分别≥0.99 和≥0.98）也高。这些检测还具有高阳性似然比（≥24）、低阴性似然比（≤0.15）和高诊断比值比（≥136）。
结论
我们的结果不支持使用抗-nGli 检测来诊断幼儿乳糜泻。IgA-anti-tTG、IgA-EmA 和 IgG-anti-dGli 的表现优于 anti-nGli。
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