Rubio-Tapia Alberto, Ludvigsson Jonas F, Choung Rok Seon, Brantner Tricia L, Rajkumar S Vincent, Landgren Ola, Murray Joseph A
Division of Gastroenterology and Hepatology, Department of Medicine, Mayo Clinic, Rochester, MN, 55905, USA.
Deparment of Pediatrics, Orebro University Hospital, Orebro, Sweden.
BMC Gastroenterol. 2016 Nov 3;16(1):136. doi: 10.1186/s12876-016-0547-8.
Immunoglobulin A (IgA) antibodies to tissue transglutaminase (tTG) are the serologic test of choice for diagnosing celiac disease (CD). Our aim was to determine if elevated IgA anti-tTG were associated with increased mortality risk.
Stored serum samples of National Health and Nutrition Examination Survey (NHANES) III (1988-1992) were available for 6032 individuals aged 50 years old or above, which were screened for IgA anti-tTG, and if positive, for IgA endomysial antibodies. Mortality was determined from the National Death Index records through 2006. Hazard ratios were calculated through Cox proportional hazards regression.
From a total of 6032, 85 participants tested positive for IgA anti-tTG (1.4 %) and 5947 tested negative. After a median follow-up of 13 years, IgA anti-tTG positive participants were at increased risk of death in both crude (HR = 1.68; 95 % CI = 1.30-2.18) and adjusted analyses (adjusted hazard ratio = 1.43; 95 % CI = 1.10-1.85) as compared to IgA anti-tTG negative participants. The excess mortality was restricted to IgA anti-tTG positive males (adjusted hazard ratio = 1.69 (95 % CI = 1.26-2.29), as opposed to a hazard ratio of 0.96 (95 % CI = 0.57-1.62) among IgA anti-tTG positive females. Although the most common cause of death in IgA anti-tTG positive participants was cardiovascular disease (36 %), the increased hazard ratio was only observed in respiratory cause of death as compared to IgA anti-tTG negative participants (adjusted hazard ratio = 5.11; 2.76-9.46).
Men aged 50 years old or above participants of NHANES III with elevated IgA anti-tTG antibodies had increased mortality risk. Elevated IgA anti-tTG antibodies could be a nonspecific marker of serious disease in older men.
抗组织转谷氨酰胺酶（tTG）的免疫球蛋白A（IgA）抗体是诊断乳糜泻（CD）的血清学首选检测方法。我们的目的是确定IgA抗tTG升高是否与死亡风险增加相关。
美国国家健康与营养检查调查（NHANES）III（1988 - 1992年）中存储的血清样本可用于6032名50岁及以上的个体，对其进行IgA抗tTG筛查，若为阳性，则进一步筛查IgA抗肌内膜抗体。通过国家死亡指数记录确定截至2006年的死亡率。通过Cox比例风险回归计算风险比。
在总共6032名个体中，85名参与者IgA抗tTG检测呈阳性（1.4%），5947名检测呈阴性。经过13年的中位随访，与IgA抗tTG阴性参与者相比，IgA抗tTG阳性参与者在粗分析（风险比[HR]=1.68；95%置信区间[CI]=1.30 - 2.18）和校正分析（校正风险比=1.43；95% CI=1.10 - 1.85）中死亡风险均增加。额外的死亡风险仅限于IgA抗tTG阳性男性（校正风险比=1.69（95% CI=1.26 - 2.29）），而IgA抗tTG阳性女性的风险比为0.96（95% CI=0.57 - 1.62）。虽然IgA抗tTG阳性参与者最常见的死亡原因是心血管疾病（36%），但与IgA抗tTG阴性参与者相比，仅在呼吸相关死亡原因中观察到风险比增加（校正风险比=5.11；2.76 - 9.46）。
NHANES III中50岁及以上且IgA抗tTG抗体升高的男性参与者死亡风险增加。IgA抗tTG抗体升高可能是老年男性严重疾病的非特异性标志物。
