Holmes Geoffrey K T, Forsyth Julia M, Knowles Sarah, Seddon Helen, Hill Peter G, Austin Andrew S
aRoyal Derby HospitalbDepartment of PathologycDerby Digestive Diseases Centre, Royal Derby Hospital, Derby, UK.
Eur J Gastroenterol Hepatol. 2017 Jun;29(6):640-645. doi: 10.1097/MEG.0000000000000841.
Growing evidence supports the view that the diagnosis of coeliac disease (CD) can be made by serological tests alone, although this approach is still not widely accepted. We previously showed in retrospective and prospective studies that in adults an IgA-tissue transglutaminase antibody cut-off can be defined above which the positive predictive value for CD is 100%. Following a change in the analytical method for measuring the antibody, our objectives were to re-examine this finding in a larger series of adults to ascertain whether a diagnosis of CD can be reliably made in a proportion of patients without the need for small bowel biopsy and to re-evaluate the diagnostic guidelines used in our centre.
A retrospective analysis was done in an unselected series of 270 adult patients who had small bowel biopsies and serum IgA-tissue transglutaminase antibody levels measured from 2009 to 2014.
At an IgA-tissue transglutaminase antibody cut-off greater than 45 U/ml (>8×upper limit of normal+2SDs) the positive predictive value for CD in this cohort was 100%; 40% of cases were above this cut-off.
We have verified that a diagnosis of CD can be reliably made in a high proportion of adults based on serology alone using the IgA-tissue transglutaminase antibody method specified. These results add to the body of evidence that small bowel biopsy should no longer be considered mandatory for the diagnosis of CD. On the basis of these results the diagnostic guidelines in our centre have been modified.
越来越多的证据支持这样一种观点，即仅通过血清学检测就可以诊断乳糜泻（CD），尽管这种方法仍未被广泛接受。我们之前在回顾性和前瞻性研究中表明，在成年人中，可以确定一个IgA组织转谷氨酰胺酶抗体临界值，高于该临界值时，CD的阳性预测值为100%。在测量该抗体的分析方法发生变化后，我们的目标是在更多的成年患者中重新检验这一发现，以确定是否可以在一部分患者中可靠地做出CD诊断而无需进行小肠活检，并重新评估我们中心使用的诊断指南。
对2009年至2014年期间进行小肠活检并检测血清IgA组织转谷氨酰胺酶抗体水平的270例成年患者进行了一项无选择的回顾性分析。
在IgA组织转谷氨酰胺酶抗体临界值大于45 U/ml（>8×正常上限+2个标准差）时，该队列中CD的阳性预测值为100%；40%的病例高于此临界值。
我们已经证实，使用指定的IgA组织转谷氨酰胺酶抗体方法，仅基于血清学就可以在很大比例的成年人中可靠地做出CD诊断。这些结果进一步证明，小肠活检不应再被视为CD诊断的必要手段。基于这些结果，我们中心的诊断指南已经修改。
