Department of Public Health, University of Cagliari, Cittadella Universitaria, Monserrato, 09045 Cagliari, Italy.
Biomed Res Int. 2013;2013:630463. doi: 10.1155/2013/630463. Epub 2013 Sep 5.
A new diagnostic tool (algorithm-1) for coeliac disease (CD) permitting the diagnosis without performing the duodenal biopsy has been recently proposed by the European Society for Paediatric Gastroenterology, Hepatology, and Nutrition (ESPGHAN). It combines symptoms associated with CD, high anti-transglutaminase type 2 antibody (anti-TG2) levels, anti-endomysium-IgA antibodies (EMA), and at-risk HLA. Our aims were (i) to evaluate retrospectively in 227 individuals (149 CD patients and 78 controls) the algorithm-1, (ii) to reduce the number of duodenal biopsies among CD patients for whom algorithm-1 is not applicable through the addition of antiactin IgA antibodies (AAA-IgA), and (iii) to evaluate prospectively algorithm-1 and AAA-IgA in 50 patients with suspected CD. Algorithm-1 identified 70 out of 149 CD patients with Marsh 3 lesions. Adding AAA-IgA to the remaining patients with anti-TG2 levels comprised between 4 and 10 times upper limit of normal (ULN) allowed the detection of further 20 patients with a Marsh 3 damage. In our prospective study, algorithm-1 identified 23 out of 50 patients, whilst further 7 were recognized adding AAA-IgA. We confirm that algorithm-1 may avoid the duodenal biopsy in many CD patients and underscores the usefulness of AAA-IgA in reducing the number of duodenal biopsies in patients with moderate anti-TG2 levels.
一种新的用于乳糜泻 (CD) 的诊断工具（算法-1）最近由欧洲儿科胃肠病学、肝病学和营养学会 (ESPGHAN) 提出，可以在不进行十二指肠活检的情况下进行诊断。它结合了与 CD 相关的症状、高水平的抗转谷氨酰胺酶 2 抗体 (anti-TG2)、抗内肌层 IgA 抗体 (EMA) 和高危 HLA。我们的目的是：(i) 回顾性评估 227 名个体（149 名 CD 患者和 78 名对照者）的算法-1；(ii) 通过添加抗肌动蛋白 IgA 抗体 (AAA-IgA)，减少不适用算法-1 的 CD 患者的十二指肠活检数量；(iii) 前瞻性评估 50 名疑似 CD 患者的算法-1 和 AAA-IgA。算法-1 识别出 149 名 CD 患者中的 70 名存在 Marsh 3 病变。将抗-TG2 水平在 4 至 10 倍正常值上限 (ULN) 之间的剩余患者添加 AAA-IgA，可进一步检测到 20 名存在 Marsh 3 损伤的患者。在我们的前瞻性研究中，算法-1 识别出 50 名患者中的 23 名，而进一步添加 AAA-IgA 则识别出另外 7 名。我们证实，算法-1 可避免许多 CD 患者进行十二指肠活检，并强调了 AAA-IgA 在减少中等水平抗-TG2 患者的十二指肠活检数量方面的有用性。
