Department of Internal Medicine, Endocrine-Metabolic Science and Biochemistry, Biochemistry Section, University of Siena, Siena, Italy.
J Clin Lab Anal. 2013 Jan;27(1):21-6. doi: 10.1002/jcla.21556. Epub 2013 Jan 4.
Serum autoantibodies specifically directed toward intracellular cytoskeletal actin filaments (anti-actin antibodies, AAA) were found to be associated with intestinal villous atrophy (IVA) in celiac disease (CD). The aim of this study was to assess IgA-AAA with a commercial test that uses sections of rat intestinal epithelial cells in a well-selected cohort of patients and to evaluate the relationship between the presence of serum IgA-AAA and the severity of intestinal mucosa damage.
Serum samples from 70 CD patients and 150 controls subjects were analyzed retrospectively for the presence of IgA-AAA.
The indirect immunofluorescence test that we used has a specificity of 100%; the sensitivity of the test is not high (25.7%). In this study we also show that serum AAA are more frequently positive in CD patients with total IVA (77.8%) and that this association is significant
IgA-AAA certainly cannot take the place of much more sensitive tests such as a-tTG and EMA in the diagnosis of CD because of their low sensitivity; nonetheless, these antibodies could be determined in a-tTG and/or EMA positive patients who cannot undergo an intestinal biopsy because of a severe contraindication, or in the case of negative consensus regarding endoscopy, or when the histology interpretation is difficult.
In conclusion, the IFI commercial test with intestinal epithelial cells as substrate offers a useful method for IgA-AAA determination. Serum IgA-AAA positivity is indicative of more severe intestinal histology damage and their assay could be a real help to the clinician, especially in the complicated cases.
在乳糜泻（CD）中，发现针对细胞内细胞骨架肌动蛋白丝的血清自身抗体（抗肌动蛋白抗体，AAA）与肠绒毛萎缩（IVA）有关。本研究的目的是使用商业测试评估使用大鼠肠上皮细胞切片的 IgA-AAA，该测试在精选的患者队列中进行，并评估血清 IgA-AAA 的存在与肠黏膜损伤严重程度之间的关系。
回顾性分析了 70 例 CD 患者和 150 例对照者的血清样本中是否存在 IgA-AAA。
我们使用的间接免疫荧光试验特异性为 100%；该试验的敏感性不高（25.7%）。在这项研究中，我们还表明，血清 AAA 在患有完全 IVA 的 CD 患者中更频繁地呈阳性，并且这种关联具有统计学意义。
由于敏感性低，IgA-AAA 肯定不能替代更敏感的测试，如 a-tTG 和 EMA，用于 CD 的诊断；但是，可以在 a-tTG 和/或 EMA 阳性的患者中确定这些抗体，这些患者由于严重的禁忌症而无法进行肠活检，或者在共识内镜检查呈阴性时，或者在组织学解释困难时。
总之，以肠上皮细胞为底物的 IFI 商业测试为 IgA-AAA 的测定提供了一种有用的方法。血清 IgA-AAA 阳性提示更严重的肠道组织学损伤，其检测可能对临床医生有真正的帮助，特别是在复杂的情况下。
