Immunopathology and Allergology, Azienda Ospedaliero-Universitaria, Piazza S. Maria della Misericordia 15, 33100 Udine, Italy.
Laboratory of Clinical Pathology, San Antonio Hospital, via Morgagni 18, 33028 Tolmezzo, UD, Italy.
Autoimmun Rev. 2014 Apr-May;13(4-5):472-6. doi: 10.1016/j.autrev.2014.01.043. Epub 2014 Jan 15.
Celiac disease is a complex disorder, the development of which is controlled by a combination of genetic (HLA alleles) and environmental (gluten ingestion) factors. New diagnostic guidelines developed by ESPGHAN emphasize the crucial role of serological tests in the diagnostic process of symptomatic subjects, and of the detection of HLA DQ2/DQ8 alleles in defining a diagnosis in asymptomatic subjects belonging to at-risk groups. The serological diagnosis of CD is based on the detection of class IgA anti-tissue transglutaminase (anti-tTG) and anti-endomysial antibodies. In patients with IgA deficiency, anti-tTG or anti-deamidated gliadin peptide antibody assays of the IgG class are used. When anti-tTG antibody levels are very high, antibody specificity is absolute and CD can be diagnosed without performing a duodenum biopsy. Non-celiac gluten sensitivity is a gluten reaction in which both allergic and autoimmune mechanisms have been ruled out. Diagnostic criteria include the presence of symptoms similar to those of celiac or allergic patients; negative allergological tests and absence of anti-tTG and EMA antibodies; normal duodenal histology; evidence of disappearance of the symptoms with a gluten-free diet; relapse of the symptoms when gluten is reintroduced.
乳糜泻是一种复杂的疾病，其发展受遗传（HLA 等位基因）和环境（麸质摄入）因素的共同控制。ESP-GHAN 制定的新诊断指南强调了血清学检测在有症状患者的诊断过程中的关键作用，以及在无症状的属于高危人群的患者中检测 HLA DQ2/DQ8 等位基因在确定诊断中的重要性。CD 的血清学诊断基于检测 class IgA 抗组织转谷氨酰胺酶（anti-tTG）和抗内膜抗体。在 IgA 缺乏的患者中，使用 IgG 类的抗 tTG 或抗脱酰胺麦胶蛋白肽抗体检测。当抗 tTG 抗体水平非常高时，抗体特异性是绝对的，无需进行十二指肠活检即可诊断 CD。非乳糜泻麸质敏感是一种麸质反应，其中已排除过敏和自身免疫机制。诊断标准包括存在类似于乳糜泻或过敏患者的症状；过敏检测阴性，且无抗 tTG 和 EMA 抗体；十二指肠组织学正常；无麸质饮食可使症状消失的证据；重新引入麸质后症状复发。
