Valle Julio, Morgado José Mario T, Ruiz-Martín Juan, Guardiola Antonio, Lopes-Nogueras Miriam, García-Vela Almudena, Martín-Sacristán Beatriz, Sánchez-Muñoz Laura
Department of Gastroenterology, Complejo Hospitalario de Toledo, Spain.
Instituto de Estudios de Mastocitosis de Castilla La Mancha, Complejo Hospitalario de Toledo, Spain.
United European Gastroenterol J. 2017 Oct;5(6):819-826. doi: 10.1177/2050640616682181. Epub 2016 Nov 24.
Diagnosis of celiac disease is difficult when the combined results of serology and histology are inconclusive. Studies using flow cytometry of intraepithelial lymphocytes (IELs) have found that celiac patients have increased numbers of γδ IELs, along with a decrease in CD3-CD103 + IELs.
The objective of this article is to assess the role of flow cytometric analysis of IELs in the diagnosis of celiac disease in difficult cases.
A total of 312 patients with suspicion of celiac disease were included in the study. Duodenal biopsy samples were used for histological assessment and for flow cytometric analysis of IELs.
In 46 out of 312 cases (14.7%) the combination of serology and histology did not allow the confirmation or exclusion of celiac disease. HLA typing had been performed in 42 of these difficult cases. Taking into account HLA typing and the response to a gluten-free diet, celiac disease was excluded in 30 of these cases and confirmed in the remaining 12. Flow cytometric analysis of IELs allowed a correct diagnosis in 39 out of 42 difficult cases (92.8%) and had a sensitivity of 91.7% (95% CI: 61.5% to 99.8%) and a specificity of 93.3% (95% CI: 77.9% to 99.2%) for the diagnosis of celiac disease in this setting.
Flow cytometric analysis of IELs is useful for the diagnosis of celiac disease in difficult cases.
当血清学和组织学的联合结果不确定时，乳糜泻的诊断较为困难。使用上皮内淋巴细胞（IEL）流式细胞术的研究发现，乳糜泻患者的γδ IEL数量增加，同时CD3-CD103 + IEL数量减少。
本文的目的是评估IEL流式细胞术分析在疑难病例乳糜泻诊断中的作用。
共有312例疑似乳糜泻患者纳入研究。十二指肠活检样本用于组织学评估和IEL的流式细胞术分析。
在312例病例中的46例（14.7%）中，血清学和组织学联合检查无法确诊或排除乳糜泻。其中42例疑难病例进行了HLA分型。综合考虑HLA分型和无麸质饮食反应，这些病例中有30例排除了乳糜泻，其余12例确诊。IEL流式细胞术分析在42例疑难病例中的39例（92.8%）中做出了正确诊断，在这种情况下诊断乳糜泻的敏感性为91.7%（95%CI：61.5%至99.8%），特异性为93.3%（95%CI：77.9%至99.2%）。
IEL流式细胞术分析对疑难病例乳糜泻的诊断有用。
