Clinical Trial Centre, University of Leipzig, Germany.
Institute of Laboratory Medicine, Clinical Chemistry and Molecular Diagnostics, Medical Faculty of the University, University Hospital, Leipzig, Germany.
Clin Gastroenterol Hepatol. 2018 Sep;16(9):1442-1449.e5. doi: 10.1016/j.cgh.2018.04.008. Epub 2018 Apr 12.
BACKGROUND & AIMS: Celiac disease can be identified by a serologic test for IgA against tissue transglutaminase (IgA-TTG) in a large proportion of children. However, the increased concentrations of antibody rarely normalize within the months after children are placed on a gluten-free diet (GFD). Early serologic predictors of sufficient adherence to GFD are required for optimal treatment.
In a prospective study, we observed the response to a GFD in 345 pediatric patients (67% girls; mean age, 8.4 y) who underwent duodenal biopsy to confirm or refute celiac disease from October 2012 through December 2015. Baseline serum samples were tested centrally for IgA-TTG and IgG against deamidated gliadin. Follow-up serologic analyses of children on a GFD were performed about 3 months later.
The geometric mean concentration of IgA-TTG decreased from 72.4-fold to 5.2-fold the upper limit of normal (ULN), or by a factor of 14.0 (95% CI, 12.0-16.4). A substantial response (defined as a larger change than the typical variation in patients not on a GFD) was observed in 80.6% of the children. Only 28.1% of patients had a substantial response in the concentration of IgG against deamidated gliadin. Concentration of IgA-TTG remained above 1-fold the ULN in 83.8% of patients, and above 10-fold the ULN in 26.6% of patients with a substantial response.
Serum concentration of IgA-TTG decreases substantially in most children with celiac disease within 3 months after they are placed on a GFD, but does not normalize in most. This information on changes in antibody concentrations can be used to assess patient response to the diet at short-term follow-up evaluations. Patients with a substantial response to a GFD often still have high antibody levels after 3 months. German Clinical Trials Registry no. DRKS00003854.
在很大一部分儿童中，针对组织转谷氨酰胺酶（IgA-TTG）的 IgA 血清学检测可识别乳糜泻。然而，在儿童开始无麸质饮食（GFD）后的数月内，抗体浓度很少恢复正常。需要早期的血清学预测因子来预测 GFD 的充分依从性，以实现最佳治疗效果。
在一项前瞻性研究中，我们观察了 2012 年 10 月至 2015 年 12 月期间接受十二指肠活检以确认或排除乳糜泻的 345 例儿科患者（67%为女孩；平均年龄 8.4 岁）对 GFD 的反应。对基线血清样本进行了集中检测，以检测 IgA-TTG 和针对脱酰胺麦胶蛋白的 IgG。大约 3 个月后，对接受 GFD 的儿童进行了随访血清学分析。
IgA-TTG 的几何平均浓度从 72.4 倍降至正常上限（ULN）的 5.2 倍，或降低了 14.0 倍（95%CI，12.0-16.4）。80.6%的儿童观察到明显的反应（定义为变化大于未接受 GFD 治疗的患者的典型变化）。只有 28.1%的患者针对脱酰胺麦胶蛋白的 IgG 有明显反应。在 83.8%的患者中，IgA-TTG 的浓度仍高于 ULN 的 1 倍，在有明显反应的 26.6%的患者中，IgA-TTG 的浓度仍高于 ULN 的 10 倍。
在开始 GFD 后 3 个月内，大多数乳糜泻患儿的血清 IgA-TTG 浓度明显下降，但大多数患儿仍未恢复正常。这些抗体浓度变化的信息可用于在短期随访评估中评估患者对饮食的反应。对 GFD 有明显反应的患者在 3 个月后通常仍有较高的抗体水平。德国临床试验注册处编号 DRKS00003854。
