Centre for Social Policy Research, University of Bremen, Bremen, Germany.
J Pediatr Gastroenterol Nutr. 2012 Feb;54(2):229-41. doi: 10.1097/MPG.0b013e318216f2e5.
The aim of this study was to summarise the evidence from 2004 to September 2009 on the performance of laboratory-based serological and point of care (POC) tests for diagnosing coeliac disease (CD) in children using histology as reference standard.
We searched MEDLINE and EMBASE for studies reporting on children for tests based on IgA and IgG anti-gliadin (AGA), endomysial (EmA), anti-transglutaminase-2 (TG2), and anti-deamidated gliadin peptides (DGP) antibodies or POC tests. For inclusion, histological analysis of duodenal biopsies and sensitivity and specificity for index tests had to be reported. Data were pooled and summary measures calculated for sensitivity, specificity, positive and negative likelihood ratios ("LR+", "LR-"), and diagnostic odds ratios (DOR). In case of elevated statistical heterogeneity, studies reaching 90% sensitivity or specificity were reported.
A total of 2510 articles were reviewed; 16 entered meta-analysis, reporting on 3110 patients (1876 with CD, 1234 without CD). For IgA-EmA, sensitivity was ≥90% in 7/11 studies and pooled specificity 98.2%. For IgA-anti-TG2, 11/15 studies yielded sensitivities ≥90% and 13/15 specificities ≥90%. For IgA-DGP, sensitivity ranged between 80.7% and 95.1% (specificity 86.3%-93.1%); for IgG-DGP between 80.1% and 98.6% (specificity 86.0-96.9%). IgA-EmA had the highest pooled DOR (554) and LR+ (31.8) for a laboratory test, followed by IgA-anti-TG2, IgG-DGP, IgA-DGP and IgA-AGA. POC tests showed a pooled sensitivity of 96.4% for IgA-TG2 (specificity 97.7%).
IgA-EmA and IgA-anti-TG2 tests appear highly accurate to diagnose CD. IgG-anti-DGP tests may help in excluding CD. IgA-AGA and IgA-DGP tests show inferior accuracy. POC tests may achieve high accuracy in the hands of experienced readers, but IgA-anti-TG2/EmA were superior.
本研究旨在总结 2004 年至 2009 年 9 月间，以组织学为参考标准，基于 IgA 和 IgG 抗谷蛋白（AGA）、抗内肌膜（EmA）、抗转谷氨酰胺酶-2（TG2）和抗脱酰胺谷蛋白肽（DGP）抗体或即时检测（POC）试验诊断儿童乳糜泻（CD）的证据。
我们检索了 MEDLINE 和 EMBASE，以获取关于儿童基于 IgA 和 IgG 抗谷蛋白（AGA）、抗内肌膜（EmA）、抗转谷氨酰胺酶-2（TG2）和抗脱酰胺谷蛋白肽（DGP）抗体或 POC 试验的研究报告。纳入标准为：十二指肠活检的组织学分析以及索引试验的敏感性和特异性。对数据进行汇总，并计算敏感性、特异性、阳性和阴性似然比（“LR+”、“LR-”）和诊断比值比（DOR）。如果存在统计学上的显著异质性，则报告达到 90%敏感性或特异性的研究。
共回顾了 2510 篇文章，其中 16 篇进入荟萃分析，共纳入 3110 例患者（1876 例 CD，1234 例非 CD）。11 项研究的 IgA-EmA 敏感性≥90%，汇总特异性为 98.2%。15 项研究中，11 项 IgA-anti-TG2 的敏感性≥90%，15 项特异性均≥90%。IgA-DGP 的敏感性在 80.7%至 95.1%之间（特异性在 86.3%-93.1%之间）；IgG-DGP 在 80.1%至 98.6%之间（特异性在 86.0-96.9%之间）。对于实验室检测，IgA-EmA 的汇总诊断比值比（DOR）最高（554），阳性似然比（LR+）最高（31.8），其次是 IgA-anti-TG2、IgG-DGP、IgA-DGP 和 IgA-AGA。POC 检测的 IgA-TG2 敏感性汇总值为 96.4%（特异性 97.7%）。
IgA-EmA 和 IgA-anti-TG2 检测对诊断 CD 具有高度准确性。IgG-anti-DGP 检测可能有助于排除 CD。IgA-AGA 和 IgA-DGP 检测的准确性较低。POC 检测在经验丰富的检测者手中可能具有较高的准确性，但 IgA-anti-TG2/EmA 更具优势。
