Le Fevre Anna K, Walker Marjorie M, Hadjiashrafy Amir, Bhatia Rani, Mattes Joerg, Talley Nicholas J, Nightingale Scott
*Priority Research Centre GrowUpWell, University of Newcastle and HMRI †Anatomical Pathology, Faculty of Health and Medicine, University of Newcastle ‡Department of Anatomical Pathology, Pathology North, John Hunter Hospital §Department of Paediatric Allergy and Immunology ||Department of Respiratory and Sleep Medicine, John Hunter Children's Hospital ¶Faculty of Health and Medicine, University of Newcastle #Department of Gastroenterology, John Hunter Children's Hospital, Newcastle, Australia.
J Pediatr Gastroenterol Nutr. 2017 Jul;65(1):69-74. doi: 10.1097/MPG.0000000000001437.
This study compared the clinical and histopathological characteristics of children with eosinophilic esophagitis (EoE) and elevated anti-transglutaminase (TTG Ab) with those with EoE and normal TTG Ab titres.
Single-center chart and blinded histopathological review of patients diagnosed with EoE for a 4-year period, who had esophageal and duodenal biopsies taken at time of endoscopy, and TTG Ab measured within 6 months of biopsy. Patients with histology-proven CD were excluded.
Elevated TTG Ab was present in 19/34 (54%) of the study cohort, representing 23% of all patients diagnosed with EoE during the study period. Eight had titers >6× upper limit of normal (ULN) and 4 had >10× ULN. TTG Ab-positive patients were classified as having either potential CD with (n = 3, 16%) and without lymphocytic duodenosis (LD; n = 12, 63%), and no CD (n = 4, 21%) on human leukocyte antigen typing. There was an increase in duodenal eosinophils in patients with elevated TTG Ab (P = 0.01), which remained when patients with LD were excluded (P = 0.018). Of 19 patients with EoE and elevated TTG Ab, 5 responded to elimination diet involving exclusion of wheat, including 2 with a sole wheat trigger and TTG Ab >10× ULN that were CD-associated human leukocyte antigen-negative.
Serum TTG Ab was elevated in almost one-quarter of our total EoE cohort, and at least 20% of these patients did not have potential CD, suggesting EoE is a heterogeneous disease with differing immune mechanisms activated in some patients. These findings also support routine esophageal biopsy during upper endoscopy in children with elevated TTG Ab.
本研究比较了抗转谷氨酰胺酶（TTG Ab）升高的嗜酸性食管炎（EoE）患儿与TTG Ab正常的EoE患儿的临床和组织病理学特征。
对在4年期间被诊断为EoE的患者进行单中心病历和盲法组织病理学回顾，这些患者在内镜检查时进行了食管和十二指肠活检，并在活检后6个月内检测了TTG Ab。组织学确诊为乳糜泻（CD）的患者被排除。
研究队列中19/34（54%）的患者TTG Ab升高，占研究期间所有诊断为EoE患者的23%。8例患者的滴度>正常上限（ULN）的6倍，4例患者的滴度>ULN的10倍。根据人类白细胞抗原分型，TTG Ab阳性患者被分类为有潜在CD伴淋巴细胞性十二指肠炎（LD；n = 3，16%）和无LD（n = 12，63%），以及无CD（n = 4, 21%）。TTG Ab升高的患者十二指肠嗜酸性粒细胞增多（P = 0.01），排除LD患者后仍存在（P = 0.018）。在19例EoE且TTG Ab升高的患者中，5例对排除小麦的消除饮食有反应，其中2例仅对小麦过敏且TTG Ab>ULN的10倍，为CD相关人类白细胞抗原阴性。
在我们所有的EoE队列中，近四分之一的患者血清TTG Ab升高，其中至少20%的患者没有潜在CD，这表明EoE是一种异质性疾病，在一些患者中激活了不同的免疫机制。这些发现也支持对TTG Ab升高的儿童进行上消化道内镜检查时常规进行食管活检。
