Çakır Murat, Baran Maşallah, Uçar Fahri, Akbulut Ulaş Emre, Kaklıkkaya Neşe, Ersöz Şafak
Division of Pediatric Gastroenterology, Hepatology and Nutrition, Department of Pediatrics, Karadeniz Technical University, Trabzon, Turkey.
Turk J Pediatr. 2014 Jul-Aug;56(4):347-53.
The aim of the study was to analyze the accuracy of (i) HLA-DQ typing and anti-tissue transglutaminase antibodies immunoglobulin A (tTG-IgA) serology and (ii) a "simple scoring system" (SSS) for the diagnosis of celiac disease (CD). The study included 91 patients with positive tTG-IgA, who had been tested for HLA-DQ. Patients were divided into 3 groups: typical CD, atypical CD, and non-CD. The sensitivity, specificity, positive (PPV) and negative predictive value (NPV), positive (PLR) and negative likelihood ratio (NLR) and accuracy of the test combining genotyping and tTG-IgA positivity and the simple scoring system for the diagnosis of CD were evaluated. The combination of genotyping and strong tTG-IgA positivity had a sensitivity of 93.5%, specificity of 61.5%, PPV of 93.5%, NPV of 61.5%, PLR of 2.4, NLR of 0.1 and accuracy of 89% for "CD." SSS had a higher specificity (84.6%), higher PPV (97.3%), higher NPV (68.7%), higher PLR and higher accuracy (92.3%). The combination of genotyping and strong tTG-IgA positivity missed two patients with typical CD (4%) and three patients with atypical CD (10.7%). Two cases with malabsorptive symptoms (33.3%) and three patients without malabsorptive symptoms (42.8%) would have been misdiagnosed as CD if these tests were used. Intestinal biopsy is still mandatory for diagnosis of CD in Turkish children.
该研究的目的是分析（i）人类白细胞抗原-DQ（HLA-DQ）分型和抗组织转谷氨酰胺酶抗体免疫球蛋白A（tTG-IgA）血清学以及（ii）一种“简易评分系统”（SSS）用于诊断乳糜泻（CD）的准确性。该研究纳入了91例tTG-IgA呈阳性且已进行HLA-DQ检测的患者。患者被分为3组：典型CD、非典型CD和非CD。评估了将基因分型与tTG-IgA阳性以及简易评分系统相结合用于诊断CD的检测的敏感性、特异性、阳性预测值（PPV）和阴性预测值（NPV）、阳性似然比（PLR）和阴性似然比（NLR）以及准确性。基因分型与强tTG-IgA阳性相结合对“CD”的敏感性为93.5%，特异性为61.5%，PPV为93.5%，NPV为61.5%，PLR为2.4，NLR为0.1，准确性为89%。SSS具有更高的特异性（84.6%）、更高的PPV（97.3%）、更高的NPV（68.7%）、更高的PLR和更高的准确性（92.3%）。基因分型与强tTG-IgA阳性相结合漏诊了2例典型CD患者（4%）和3例非典型CD患者（10.7%）。如果使用这些检测方法，2例有吸收不良症状的患者（33.3%）和3例无吸收不良症状的患者（42.8%）会被误诊为CD。在土耳其儿童中，肠道活检对于CD的诊断仍然是必需的。
