Lammi Anne, Arikoski Pekka, Simell Satu, Kinnunen Tuure, Simell Ville, Paavanen-Huhtala Sari, Hinkkanen Ari, Veijola Riitta, Knip Mikael, Toppari Jorma, Vaarala Outi, Simell Olli, Ilonen Jorma
*Department of Clinical Microbiology †Department of Pediatrics, University of Eastern Finland ‡Department of Pediatrics and Adolescent Medicine, University of Turku, Turku §A.I. Virtanen Institute for Molecular Sciences, University of Eastern Finland, Kuopio ||Department of Pediatrics, University of Oulu and Oulu University Hospital, Oulu ¶Children's Hospital, University of Helsinki, Helsinki #Institute of Clinical Medicine, University of Helsinki, Helsinki, Finland.
J Pediatr Gastroenterol Nutr. 2015 May;60(5):626-31. doi: 10.1097/MPG.0000000000000666.
Determination of antibodies to synthetic deamidated gliadin peptides (anti-DGPs) may work as an alternative or complement the commonly used test for tissue transglutaminase antibodies (TGA) in the diagnosis of celiac disease (CD). We analyzed the performance of a time-resolved immunofluorometric anti-DGP assay (TR-IFMA) in the diagnosis of CD in children and also retrospectively analyzed the appearance of anti-DGP antibodies before TGA seroconversion.
The study included 92 children with biopsy-confirmed CD. Serum samples were taken at the time or just before the clinical diagnosis. The control group comprised 82 TGA-negative children who were positive for human leucocyte antigen-DQ2 or -DQ8.
Based on receiver operating characteristic curves, the optimal cutoff value for immunoglobulin (Ig) A anti-DGP positivity was 153 arbitrary units (AUs) with a sensitivity of 92.4% and specificity of 97.6% and that for IgG anti-DGP 119 AU, with a sensitivity of 97.8% and specificity of 97.6%. All 92 children with CD were either IgA or IgG anti-DGP positive at the time of diagnosis. Sera from 48 children with CD were also analyzed retrospectively before the diagnosis. Anti-DGP antibodies preceded TGA positivity in 35 of the 48 children with CD and appeared a median of 1 year earlier.
The TR-IFMA assay for detecting anti-DGP antibodies shows high sensitivity and specificity for the diagnosis of CD in children. In a majority of our study population, anti-DGP seropositivity preceded TGA positivity, indicating that earlier detection of CD may be possible by monitoring anti-DGP antibodies frequently in genetically susceptible children.
在乳糜泻（CD）诊断中，检测合成去酰胺化麦醇溶蛋白肽抗体（抗DGP）可作为组织转谷氨酰胺酶抗体（TGA）常用检测方法的替代或补充。我们分析了时间分辨免疫荧光法抗DGP检测（TR - IFMA）在儿童CD诊断中的性能，并回顾性分析了TGA血清转化前抗DGP抗体的出现情况。
该研究纳入92例经活检确诊为CD的儿童。在临床诊断时或诊断前采集血清样本。对照组包括82例人类白细胞抗原 - DQ2或 - DQ8阳性的TGA阴性儿童。
根据受试者工作特征曲线，免疫球蛋白（Ig）A抗DGP阳性的最佳临界值为153任意单位（AU），敏感性为92.4%，特异性为97.6%；IgG抗DGP的最佳临界值为119 AU，敏感性为97.8%，特异性为97.6%。所有92例CD患儿在诊断时IgA或IgG抗DGP均为阳性。还对48例CD患儿诊断前的血清进行了回顾性分析。48例CD患儿中有35例抗DGP抗体在TGA阳性之前出现，且出现时间中位数早1年。
检测抗DGP抗体的TR - IFMA检测法对儿童CD诊断具有高敏感性和特异性。在我们的大多数研究人群中，抗DGP血清阳性先于TGA阳性，这表明通过对遗传易感性儿童频繁监测抗DGP抗体，可能更早地检测出CD。
