Department of Medicine and Research Laboratory of Internal Medicine, Medical School, University of Thessaly, Larissa, Greece.
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.
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.
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(+).
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。
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。
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(+)。
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。
