Department of Paediatric Gastroenterology, Bristol Royal Hospital for Children, Bristol, UK.
Medical School, University of Bristol, Bristol, UK.
Arch Dis Child. 2017 Oct;102(10):942-946. doi: 10.1136/archdischild-2016-312027. Epub 2017 May 8.
European Society for Paediatric Gastroenterology, Hepatology and Nutrition (ESPGHAN) guidelines for diagnosing paediatric coeliac disease (CD) were revised in 2012. This enabled serological diagnosis in a selective group of symptomatic children using anti-tissue transglutaminase (anti-tTG) titre, antiendomysial antibodies (EMA) and HLA DQ2/DQ8 status. However, observing variations in the availability of serological tests for CD within our region, we conducted a countrywide survey to explore the diversity of these tests for all paediatric centres.
A nationwide telephone survey among biomedical scientists based in 139 National Health Service hospital trusts providing paediatric services in England was conducted by a single interviewer over a defined 3-week period. Respondents were asked about type of anti-tTG assay, the upper limit of normal (ULN) for anti-tTG titres, availability of EMA and reporting of IgA concentration.
Responses were available from 134 (96.4%) laboratories. Anti-tTG titres are performed by 83/134 (62.6%) laboratories and 68/83 (81.4%) of those also offered EMA testing. Four different anti-tTG assays are available in England, but there are 10 different ULN values. The range for ULN varies widely from 4 to 30 IU/mL. Automatic reporting of total IgA concentration for a coeliac serology request occurs in only 24/83 laboratories.
Significant heterogeneity exists for serological tests for CD in particular anti-tTG titre reporting even within the same regions. This potentially affects the interpretation of the results by clinicians diagnosing CD and hence harbouring diagnostic inconsistencies in their practice. Standardisation especially of the anti-tTG assays and routine reporting of IgA concentration nationally should be strongly considered to support the current diagnostic process for CD.
欧洲小儿胃肠病学、肝病学和营养学学会（ESPGHAN）于 2012 年修订了小儿乳糜泻（CD）的诊断指南。这使得在有症状的儿童中使用抗组织转谷氨酰胺酶（anti-tTG）滴度、抗内膜抗体（EMA）和 HLA DQ2/DQ8 状态对一组选择性儿童进行血清学诊断成为可能。然而，由于观察到我们所在地区 CD 的血清学检测方法存在差异，我们进行了一项全国性调查，以探索所有儿科中心的这些检测方法的多样性。
在英格兰，通过一名访谈者在规定的 3 周时间内对 139 家提供儿科服务的国民保健服务医院信托基金中的生物医学科学家进行了全国范围内的电话调查。受访者被问及抗 tTG 检测的类型、抗 tTG 滴度的正常值上限（ULN）、EMA 的可用性以及 IgA 浓度的报告。
134 个（96.4%）实验室提供了回复。83/134（62.6%）个实验室进行了抗 tTG 滴度检测，其中 68/83（81.4%）个实验室还提供了 EMA 检测。在英国，有四种不同的抗 tTG 检测方法，但有 10 种不同的 ULN 值。ULN 的范围从 4 到 30 IU/mL 不等，差异很大。在 83 个实验室中，仅有 24 个实验室自动报告乳糜泻血清学请求的总 IgA 浓度。
即使在同一地区，CD 的血清学检测，特别是抗 tTG 滴度报告也存在显著的异质性。这可能会影响到诊断 CD 的临床医生对结果的解释，从而导致他们在实践中的诊断不一致。特别是应该强烈考虑在全国范围内对抗 tTG 检测进行标准化，并常规报告 IgA 浓度，以支持目前的 CD 诊断流程。
