Gidrewicz Dominica, Potter Kathryn, Trevenen Cynthia L, Lyon Martha, Butzner J Decker
Department of Pediatrics, University of Calgary, Calgary, Alberta, Canada.
Department of Pathology and Laboratory Medicine, University of Calgary, Calgary, Alberta, Canada.
Am J Gastroenterol. 2015 May;110(5):760-7. doi: 10.1038/ajg.2015.87. Epub 2015 Mar 31.
We retrospectively examined the performance of the tissue transglutaminase (TTG), endomysial antibody (EMA) tests, and the ESPGHAN (European Society of Paediatric Gastroenterology, Hepatology and Nutrition) nonbiopsy criteria in a pediatric population.
Consecutive celiac serologies and corresponding intestinal biopsy results were obtained on children <18 years old over 3.5 years. Patients were classified into three categories: positive TTG, negative TTG, and IgA deficiency.
Of the 17,505 patients with celiac serology performed, 775 had a positive TTG, 574 with a negative TTG were biopsied, and 25 were IgA deficient. Of the patients with a TTG ≥10 × upper limit of normal (ULN), positive EMA, and symptoms, 98.2% had biopsies consistent with celiac disease (CD). Four human leukocyte antigen (HLA) DQ2/DQ8-positive patients who met the ESPGHAN nonbiopsy criteria did not have CD. In the group with a TTG 3-10 × ULN, 75.7% EMA-positive patients and only 40% EMA-negative patients had CD (P<0.001). Of those with a TTG 1-3 × ULN, 52.2% EMA-positive patients vs. only 13.3% EMA-negative patients had CD (P<0.01). Of the patients with bulbar and duodenal biopsies, 9.8% had CD confined only in the bulb, especially those with a low titer TTG (P<0.01). CD prevalence in our cohort was 34.6%. Sensitivity, specificity, and positive predictive value of the TTG were 98.7%, 86.4%, and 79.4%, respectively.
The TTG is a very sensitive screen for CD, but positive predictive value improves with a positive EMA titer. To apply the new ESPGHAN guidelines, clinicians must understand the performance of their celiac serology tests.
我们回顾性研究了组织转谷氨酰胺酶（TTG）、肌内膜抗体（EMA）检测以及欧洲儿科胃肠病、肝病和营养学会（ESPGHAN）非活检标准在儿科人群中的表现。
在3.5年期间获取了18岁以下儿童连续的乳糜泻血清学检查结果及相应的肠道活检结果。患者被分为三类：TTG阳性、TTG阴性和IgA缺乏。
在进行乳糜泻血清学检查的17505例患者中，775例TTG阳性，574例TTG阴性患者接受了活检，25例为IgA缺乏。在TTG≥10×正常上限（ULN）、EMA阳性且有症状的患者中，98.2%的活检结果与乳糜泻（CD）相符。4例符合ESPGHAN非活检标准的人类白细胞抗原（HLA）DQ2/DQ8阳性患者并无CD。在TTG为3 - 10×ULN的组中，75.7%的EMA阳性患者和仅40%的EMA阴性患者患有CD（P<0.001）。在TTG为1 - 3×ULN的患者中，52.2%的EMA阳性患者与仅13.3%的EMA阴性患者患有CD（P<0.01）。在进行球部和十二指肠活检的患者中，9.8%的患者CD仅局限于球部，尤其是那些TTG滴度较低的患者（P<0.01）。我们队列中的CD患病率为34.6%。TTG的敏感性、特异性和阳性预测值分别为98.7%、86.4%和79.4%。
TTG是CD的一种非常敏感的筛查方法，但阳性预测值会随着EMA滴度阳性而提高。为应用新的ESPGHAN指南，临床医生必须了解其乳糜泻血清学检测的表现。
