a Department of Laboratory Diagnostics and Clinical Immunology of Developmental Age , Medical University of Warsaw , Warsaw , Poland.
b Department of Pediatrics , Medical University of Warsaw , Warsaw , Poland.
Autoimmunity. 2018 Mar;51(2):81-88. doi: 10.1080/08916934.2018.1427226. Epub 2018 Jan 19.
Autoimmune diseases, such as celiac disease (CD) and diabetes mellitus type 1, tend to co-occur within the same patient. The prevalence of CD in diabetic children is higher than in the general population, and is estimated to be 0.6-16.4%. The diagnosis of CD is based on histopathological examination and serological testing, however, these methods are still imperfect and new diagnostic algorithms should be considered.
The aim of the study was to assess the diagnostic value of serological tests detecting antibodies against deamidated gliadin peptide, endomysium, tissue transglutaminase, neo-epitope tissue transglutaminase and to identify HLA-related genetic predisposition to CD in patients with type 1 diabetes mellitus (DM1).
Autoantibodies were measured in the sera of 392 children suffering from DM1 aged 1-19 years old (mean 11.76 ± 4.14 years old). Additionally, PCR-based assessment of HLA DQ2/DQ8 genotyping was performed.
A positive result of at least one serological test was obtained from 81 children (20.66%). The sensitivity and specificity were 76.47% and 91.67% for anti-DGP IgA, 70.59% and 58.33% for IgG anti-DGP, respectively. A positive predictive value was 100% for the anti-TG IgA at cutoff levels of 5 and 10 times higher than upper limit of reference values. HLA DQ2 and/or DQ8 were found in 97.6% of examined children.
Tests based on anti-TG IgA are more accurate for detecting CD in children with type 1 diabetes than anti-DGP IgA. A high percentage of diabetic children carry HLA alleles predisposing to CD, which indicates that genetic screening in this group of patients is not obligated.
自身免疫性疾病，如乳糜泻（CD）和 1 型糖尿病，往往在同一患者中同时发生。患糖尿病的儿童中 CD 的患病率高于一般人群，估计为 0.6-16.4%。CD 的诊断基于组织病理学检查和血清学检测，但这些方法仍不完善，应考虑新的诊断算法。
本研究旨在评估检测抗脱酰胺麸胶肽、内肌层、组织转谷氨酰胺酶、新表位组织转谷氨酰胺酶抗体的血清学检测对 1 型糖尿病（DM1）患者 CD 的诊断价值，并确定与 HLA 相关的遗传易感性。
对 392 名 1-19 岁（平均 11.76±4.14 岁）患 DM1 的儿童血清中的自身抗体进行了测量。此外，还进行了基于 PCR 的 HLA DQ2/DQ8 基因分型评估。
81 名儿童（20.66%）至少有一种血清学检测呈阳性。抗 DGP IgA 的敏感性和特异性分别为 76.47%和 91.67%，抗 IgG 抗 DGP 分别为 70.59%和 58.33%。当抗 TG IgA 的截断值比参考值上限高 5 倍和 10 倍时，阳性预测值为 100%。在接受检查的儿童中，97.6%存在 HLA DQ2 和/或 DQ8。
基于抗 TG IgA 的检测在检测 1 型糖尿病儿童中的 CD 比抗 DGP IgA 更准确。高比例的糖尿病儿童携带易患 CD 的 HLA 等位基因，这表明在该组患者中进行基因筛查是不必要的。
