Oldenburger Irene B, Wolters Victorien M, Kardol-Hoefnagel Tineke, Houwen Roderick H J, Otten Henny G
Department of Pediatric Gastroenterology, Wilhelmina Children's Hospital, Utrecht, The Netherlands.
Laboratory of Translational Immunology, University Medical Center Utrecht, Utrecht, The Netherlands.
APMIS. 2018 Mar;126(3):186-190. doi: 10.1111/apm.12800. Epub 2018 Jan 31.
Current diagnostic guidelines for celiac disease (CD) in pediatric patients require a duodenal biopsy if the IgA anti-tissue transglutaminase (tTG) is below 10x the upper limit of normal (ULN). Additional markers may enable a noninvasive diagnosis in this group. Serum intestinal-fatty acid-binding protein (I-FABP), a marker for intestinal epithelial damage, could be useful in this respect. A total of 95 children with a clinical suspicion of CD and tTG 1-10x ULN were investigated. All had a duodenal biopsy and analysis of serum I-FABP. A control group of 161 children with familial short stature and normal tTG was included. I-FABP levels in the 71 patients with tTG 1-10x ULN and biopsy-proven CD (median 725 pg/mL) were not significantly different (p = 0.13) from the levels in the 24 patients with a tTG 1-10x ULN but a normal biopsy (median 497 pg/mL). However, when combining tTG and I-FABP levels, 11/24 patients could have been diagnosed noninvasively if tTG is ≥ 50 U/mL and I-FABP ≥880 pg/mL or in 12/19 patients if tTG is ≥ 60 U/mL and I-FABP ≥ 620 pg/mL. Therefore, addition of I-FABP to the diagnostic procedure of CD may provide a noninvasive diagnosis in patients with a tTG ≥ 50 U/mL.
目前，儿童乳糜泻（CD）的诊断指南要求，如果IgA抗组织转谷氨酰胺酶（tTG）低于正常上限（ULN）的10倍，则需进行十二指肠活检。其他标志物可能有助于对这组患者进行非侵入性诊断。血清肠脂肪酸结合蛋白（I-FABP）是一种肠道上皮损伤标志物，在这方面可能有用。对95名临床怀疑患有CD且tTG为1-10倍ULN的儿童进行了调查。所有患儿均进行了十二指肠活检并检测了血清I-FABP。纳入了161名家族性身材矮小且tTG正常的儿童作为对照组。71名tTG为1-10倍ULN且经活检证实为CD的患者（中位数为725 pg/mL）的I-FABP水平与24名tTG为1-10倍ULN但活检正常的患者（中位数为497 pg/mL）相比，差异无统计学意义（p = 0.13）。然而，当结合tTG和I-FABP水平时，如果tTG≥50 U/mL且I-FABP≥880 pg/mL，24名患者中有11名可通过非侵入性诊断；如果tTG≥60 U/mL且I-FABP≥620 pg/mL，19名患者中有12名可通过非侵入性诊断。因此，在CD的诊断过程中加入I-FABP可能为tTG≥50 U/mL的患者提供非侵入性诊断。
