de Chaisemartin Luc, Meatchi Tchao, Malamut Georgia, Fernani-Oukil Fahima, Hosking Frédérique, Rault Dorothée, Bellery Fabienne, Cellier Christophe, Dragon-Durey Marie-Agnès
Immunology Department, Georges Pompidou European Hospital, Assistance Publique-Hôpitaux de Paris, Paris, France; INSERM UMR 996, Paris Sud University, Châtenay-Malabry, France.
Pathology Department, Georges Pompidou European Hospital, Assistance Publique-Hôpitaux de Paris, Paris, France.
PLoS One. 2015 Aug 31;10(8):e0136745. doi: 10.1371/journal.pone.0136745. eCollection 2015.
The role of serological tests such as IgA anti-transglutaminase autoantibodies has become increasingly important in celiac disease (CD) diagnosis. However, the efficiency of these tests for patient follow-up is controversial. We investigated the correlation of 12 different serological tests, including recent deamidated gliadin and actin IgA tests, with villous atrophy (VA) in a retrospective cohort of treated celiac patients.
Serum samples were collected from 100 treated CD patients who had intestinal biopsy in the course of their follow-up. Antibodies against transglutaminase, deamidated gliadin peptides, and native gliadin were measured, along with IgA anti-actin. The biopsy slides were all blind-reviewed and scored according to Marsh classification.
For all deamidated gliadin and transglutaminase tests, we found that a positive result was significantly associated with persistence of intestinal VA, with a diagnostic efficacy up to 80%. Furthermore, antibodies titers directly correlated with the degree of VA, indicating a strong link between disease activity and presence of antibodies in the serum. Interestingly, the tests with the highest association with persistent VA were those for deamidated gliadin IgG. Using a test positivity pattern analysis, we were also able to identify several groups of patients with distinct antibody profiles that showed significant differences in intestinal damage and diet compliance.
Altogether, these results show that deamidated gliadin antibodies are strongly correlated with VA and should be considered valuable tools in CD follow-up and that multiplex serologic analysis for treated CD represents a promising tool for personalized patient management.
血清学检测，如 IgA 抗转谷氨酰胺酶自身抗体，在乳糜泻（CD）诊断中的作用日益重要。然而，这些检测用于患者随访的效率存在争议。我们在一组接受治疗的乳糜泻患者回顾性队列中，研究了 12 种不同血清学检测（包括近期的去酰胺化麦醇溶蛋白和肌动蛋白 IgA 检测）与绒毛萎缩（VA）的相关性。
收集 100 例在随访过程中进行了肠道活检的接受治疗的 CD 患者的血清样本。检测抗转谷氨酰胺酶、去酰胺化麦醇溶蛋白肽和天然麦醇溶蛋白的抗体，以及 IgA 抗肌动蛋白。对活检玻片进行双盲评估，并根据 Marsh 分类进行评分。
对于所有去酰胺化麦醇溶蛋白和转谷氨酰胺酶检测，我们发现阳性结果与肠道 VA 的持续存在显著相关，诊断效能高达 80%。此外，抗体滴度与 VA 程度直接相关，表明疾病活动与血清中抗体的存在之间存在密切联系。有趣的是，与持续性 VA 相关性最高的检测是去酰胺化麦醇溶蛋白 IgG 检测。通过检测阳性模式分析，我们还能够识别出几组具有不同抗体谱的患者，这些患者在肠道损伤和饮食依从性方面存在显著差异。
总之，这些结果表明去酰胺化麦醇溶蛋白抗体与 VA 密切相关，应被视为 CD 随访中有价值的工具，并且对接受治疗的 CD 的多重血清学分析是个性化患者管理的一个有前景的工具。
