Polanco Isabel, Koester Weber Thabata, Martínez-Ojinaga Eva, Molina Manuel, Sarria Jesús
Facultad de Medicina. Universidad Autónoma de Madrid.
Universidad Estadual Paulista , Brasil.
Rev Esp Enferm Dig. 2017 Nov;109(11):743-748. doi: 10.17235/reed.2017.5028/2017.
The objective of the study was to assess the effectiveness of a point-of-care test (POCT) based on deamidated gliadin peptides (DGP) compared to the European Society for Paediatric Gastroenterology Hepatology and Nutrition (ESPGHAN) criteria diagnosis in the early detection of celiac disease (CD) in pediatric patients.
One hundred children (≤ 18 years) with suspected CD were selected, including siblings of celiac children that underwent gastroscopy for other gastrointestinal conditions. Patients with severe disease, following a gluten-free diet (GFD), with gastrointestinal bleeding, coagulopathy and infections in the last month were excluded. All children were evaluated with a POCT that detects immunoglobulin A (IgA) and immunoglobulin G (IgG) antibodies to DGP and total IgA. The POCT results were compared to CD diagnosis according to current ESPGHAN criteria. This involved the detection of IgA tissue transglutaminase (tTG) antibodies, the results of an intestinal biopsy and genetic testing.
The prevalence of CD found in the present study was 48% (95% confidence interval in parenthesis 37.9-58.2%). The results of the POCT were concordant with the CD diagnosis made according to ESPGHAN criteria: 95.8% (85.7-99.4%) sensitivity, 98.1% (89.7-99.7%) specificity, 97.9% (88.7-99.6%) positive predictive value and 96.2% (87.0-99.4%) negative predictive value. Positive and negative likelihood ratios were 49.8 (7.2-347.5) and 0.04 (0.01-0.17), respectively. The POCT showed a 100% diagnostic accuracy in children younger than ten years of age. In total, three discordant results were found.
Due to the high diagnostic accuracy in the pediatric population, the POCT can be considered as an effective tool for the early diagnosis of CD, especially in patients younger than ten years of age.
本研究的目的是评估基于去酰胺化麦醇溶蛋白多肽（DGP）的即时检验（POCT）与欧洲儿科胃肠病、肝病和营养学会（ESPGHAN）标准诊断相比，在儿科患者乳糜泻（CD）早期检测中的有效性。
选取100名疑似患有CD的儿童（≤18岁），包括因其他胃肠道疾病接受胃镜检查的乳糜泻患儿的兄弟姐妹。排除患有严重疾病、遵循无麸质饮食（GFD）、过去一个月内有胃肠道出血、凝血障碍和感染的患者。所有儿童均接受了一种检测针对DGP的免疫球蛋白A（IgA）和免疫球蛋白G（IgG）抗体以及总IgA的POCT。将POCT结果与根据当前ESPGHAN标准作出的CD诊断进行比较。这包括检测IgA组织转谷氨酰胺酶（tTG）抗体、肠道活检结果和基因检测。
本研究中发现的CD患病率为48%（括号内95%置信区间为37.9 - 58.2%）。POCT结果与根据ESPGHAN标准作出的CD诊断一致：敏感性为95.8%（85.7 - 99.4%），特异性为98.1%（89.7 - 99.7%），阳性预测值为97.9%（88.7 - 99.6%），阴性预测值为96.2%（87.0 - 99.4%）。阳性和阴性似然比分别为49.8（7.2 - 347.5）和0.04（0.01 - 0.17）。POCT在10岁以下儿童中显示出100%的诊断准确性。总共发现了3个不一致的结果。
由于在儿科人群中具有较高的诊断准确性，POCT可被视为CD早期诊断的有效工具，尤其是在10岁以下的患者中。
