Rich E J, Christie D L
Department of Pediatrics, University of Washington, Seattle.
J Pediatr Gastroenterol Nutr. 1990 Feb;10(2):174-8. doi: 10.1097/00005176-199002000-00005.
We prospectively evaluated the use of a widely used commercially available anti-gliadin antibody (AGA) panel, and compared it with the xylose absorption test in screening pediatric patients with possible celiac disease for small intestinal biopsy. Sixty children were investigated with a 1-h xylose absorption test, IgG and IgA AGA panels, and small bowel biopsy; 15 patients were diagnosed with celiac disease. The xylose was sensitive (93%) but not specific (47%) for celiac disease. The IgA AGA test had high sensitivity (100%) but low specificity (58%), while the IgA AGA test had low sensitivity (53%) but high specificity (93%) in screening for celiac disease. We conclude that the AGA panel currently available in the United States is comparable to, but not significantly different than, the xylose absorption test when used as the only laboratory test in screening for celiac disease. A two-step screening process would have best improved our ability to predict celiac disease. We recommend screening with the AGA panel, and obtaining a xylose test if only the IgG is abnormal. Biopsies should be performed in cases with high IgA AGA, or with abnormal IgG AGA and xylose values. This approach is clinically preferable, does not add cost, and spares children from unnecessary small bowel biopsies.
我们前瞻性地评估了一种广泛使用的市售抗麦醇溶蛋白抗体（AGA）检测组合，并将其与木糖吸收试验进行比较，用于筛查可能患有乳糜泻的儿科患者是否需要进行小肠活检。对60名儿童进行了1小时木糖吸收试验、IgG和IgA AGA检测组合以及小肠活检；15名患者被诊断为乳糜泻。木糖对乳糜泻敏感（93%）但不特异（47%）。IgA AGA检测敏感性高（100%）但特异性低（58%），而IgG AGA检测在筛查乳糜泻时敏感性低（53%）但特异性高（93%）。我们得出结论，在美国目前可用的AGA检测组合与木糖吸收试验相当，但在作为筛查乳糜泻的唯一实验室检测时，两者无显著差异。两步筛查过程最能提高我们预测乳糜泻的能力。我们建议先用AGA检测组合进行筛查，如果只有IgG异常则进行木糖试验。对于IgA AGA高或IgG AGA及木糖值异常的病例应进行活检。这种方法在临床上更可取，不会增加成本，还能避免儿童进行不必要的小肠活检。
