Aldaghi Mitra-Azra, Dehghani Seyed-Mohsen, Haghighat Mahmood
Department of Pediatrics, Shiraz University of Medical Sciences, Shiraz, IR Iran.
Iran J Pediatr. 2016 Feb;26(1):e3615. doi: 10.5812/ijp.3615. Epub 2016 Jan 30.
Celiac disease is an immune-mediated inflammation of the small intestine caused by sensitivity to dietary gluten in genetically sensitive individuals.
In this study, we aimed to evaluate the predictive value of tissue transglutaminase (tTG) antibodies for the diagnosis of celiac disease in a pediatric population in order to determine if duodenal biopsy can be avoided.
The subjects were selected among individuals with probable celiac disease, referring to a gastrointestinal clinic. After physical examinations and performing tissue transglutaminase-immunoglobulin A (tTG-IgA) tests, upper endoscopy was performed if serological titer was higher than 18 IU/mL. Therapy started according to pathologic results.
The sample size was calculated to be 121 subjects (69 female and 52 male subjects); the average age of subjects was 8.4 years. A significant association was found between serological titer and pathologic results; in other words, subjects with high serological titer had more positive pathologic results for celiac disease, compared to others (P < 0.001). Maximum sensitivity (65%) and specificity (65.4%) were achieved at a serological titer of 81.95 IU/ml; the calculated accuracy was lower in comparison with other studies. As the results indicated, lower antibody titer was observed in patients with failure to gain weight and higher antibody titer was reported in diabetic patients.
As the results indicated, a single serological test (tTg-IgA test) was not sufficient for avoiding intestinal biopsy.
乳糜泻是一种由遗传敏感个体对膳食麸质敏感引起的小肠免疫介导性炎症。
在本研究中，我们旨在评估组织转谷氨酰胺酶（tTG）抗体对儿科人群乳糜泻诊断的预测价值，以确定是否可以避免十二指肠活检。
研究对象从疑似乳糜泻的个体中选取，这些个体前往胃肠病诊所就诊。在进行体格检查和组织转谷氨酰胺酶 - 免疫球蛋白A（tTG - IgA）检测后，如果血清学滴度高于18 IU/mL，则进行上消化道内镜检查。根据病理结果开始治疗。
计算得出样本量为121名受试者（69名女性和52名男性受试者）；受试者的平均年龄为8.4岁。发现血清学滴度与病理结果之间存在显著关联；也就是说，与其他受试者相比，血清学滴度高的受试者乳糜泻病理结果阳性更多（P < 0.001）。血清学滴度为81.95 IU/ml时达到最大敏感性（65%）和特异性（65.4%）；与其他研究相比，计算得出的准确性较低。结果表明，体重未增加的患者抗体滴度较低，糖尿病患者抗体滴度较高。
结果表明，单一血清学检测（tTg - IgA检测）不足以避免肠道活检。
