慢性肝病患者对抗脱酰胺麦胶肽的 IgA 抗体。
IgA antibodies against deamidated gliadin peptides in patients with chronic liver diseases.
机构信息
Department of Medicine and Research Laboratory of Internal Medicine, Medical School, University of Thessaly, Larissa, Greece.
出版信息
Clin Chim Acta. 2012 Oct 9;413(19-20):1683-8. doi: 10.1016/j.cca.2012.05.015. Epub 2012 May 26.
BACKGROUND/AIMS: IgA antibodies against tissue-transglutaminase (anti-tTG-IgA) and IgA and IgG antibodies against deamidated gliadin peptides (anti-DGP-IgA and anti-DGP-IgG) are considered specific for celiac disease (CD) whereas, patients with chronic liver disorders have an increased risk of latent CD development. We investigated the prevalence and clinical significance of anti-DGP-IgA, anti-DGP-IgG and anti-tTG-IgA in a large cohort of patients with chronic liver diseases.
METHODS
668 patients without gastrointestinal symptoms (426 viral hepatitis, 94 autoimmune liver diseases, 61 alcoholic disease, 46 non-alcoholic fatty liver disease, 41 with other liver disorders) were investigated by ELISAs (INOVA Diagnostics). Patients positive for at least one autoantibody invited for a small-intestinal biopsy and HLA-DQ typing.
RESULTS
Anti-DGP-IgA were detected in 8.5%, anti-DGP-IgG in only one (0.15%, P<0.001) and anti-tTG-IgA in 5.8% of patients (P=0.05). Fifty-two were anti-DGP-IgA(+)/anti-tTG-IgA(-), 34 anti-DGP-IgA(-)/anti-tTG-IgA(+), and 5 anti-DGP-IgA(+)/anti-tTG-IgA(+). Anti-DGP-IgA positivity was associated with older age (P<0.05), cirrhosis (P<0.05) and increased IgA (P<0.05) whereas, anti-tTG-IgA only with cirrhosis (P<0.05). Histology and HLA-typing compatible with CD was revealed in 4/14 anti-DGP-IgA(+)/anti-tTG-IgA(-), 0/13 anti-DGP-IgA(-)/anti-tTG-IgA(+) and 2/2 anti-DGP-IgA(+)/anti-tTG-IgA(+). All 6 patients diagnosed with CD were anti-DGP-IgA(+) and only 2 anti-tTG-IgA(+).
CONCLUSIONS
Although a significant number of patients had detectable CD-related autoantibodies, anti-DGP-IgA test seems better than anti-tTG-IgA for unmasking occult forms of CD in patients with chronic liver disorders. The known good performance for CD diagnosis of anti-DGP-IgG test was not confirmed in this specific group of patients.
背景/目的：针对组织转谷氨酰胺酶的 IgA 抗体（抗 tTG-IgA）和针对脱酰胺麦胶蛋白肽的 IgA 和 IgG 抗体（抗 DGP-IgA 和抗 DGP-IgG）被认为是乳糜泻（CD）的特异性抗体，而患有慢性肝脏疾病的患者发生潜伏 CD 的风险增加。我们调查了在一组患有慢性肝脏疾病的患者中，抗 DGP-IgA、抗 DGP-IgG 和抗 tTG-IgA 的流行率和临床意义。
方法
通过 ELISA（INOVA 诊断）检测 668 名无胃肠道症状的患者（426 例病毒性肝炎、94 例自身免疫性肝病、61 例酒精性疾病、46 例非酒精性脂肪肝疾病、41 例其他肝脏疾病）。至少有一种自身抗体阳性的患者被邀请进行小肠活检和 HLA-DQ 分型。
结果
在患者中检测到抗 DGP-IgA 的占 8.5%，仅检测到抗 DGP-IgG 的占 0.15%（P<0.001），抗 tTG-IgA 的占 5.8%（P=0.05）。52 例为抗 DGP-IgA(+) /抗 tTG-IgA(-)，34 例为抗 DGP-IgA(-) /抗 tTG-IgA(+)，5 例为抗 DGP-IgA(+) /抗 tTG-IgA(+)。抗 DGP-IgA 阳性与年龄较大（P<0.05）、肝硬化（P<0.05）和 IgA 增加（P<0.05）相关，而抗 tTG-IgA 仅与肝硬化相关（P<0.05）。在 4/14 例抗 DGP-IgA(+) /抗 tTG-IgA(-)、0/13 例抗 DGP-IgA(-) /抗 tTG-IgA(+)和 2/2 例抗 DGP-IgA(+) /抗 tTG-IgA(+)患者中发现组织学和 HLA 分型与 CD 相符。在诊断为 CD 的 6 例患者中，均为抗 DGP-IgA(+)，仅有 2 例抗 tTG-IgA(+)。
结论
尽管有相当数量的患者存在可检测的 CD 相关自身抗体，但抗 DGP-IgA 检测似乎优于抗 tTG-IgA，可用于揭示慢性肝脏疾病患者中隐匿性 CD 形式。在这组特定患者中，抗 DGP-IgG 检测对 CD 诊断的良好性能并未得到证实。
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