Holmes Geoffrey, Ciacci Carolina
Royal Derby Hospital, Derby, UK.
Coeliac Center at Department of Medicine and Surgery, Scuola Medica Salernitana, University of Salerno, Salerno, Italy.
Gastroenterol Hepatol Bed Bench. 2018 Summer;11(3):209-215.
The development of highly performing serological tests to identify patients with coeliac disease (CD), allowed large scale screening studies to be carried out and the results transformed our understanding of the prevalence of the condition in the general population. The next logical step was to ask whether CD could be reliably diagnosed by these tests without the need for small intestinal biopsies. This was shown to be the case. Studies from Derby, UK, indicated that about half of adult patients can be diagnosed in this way and similar figures have been provided for children. When considering this approach, it is essential that laboratories only use highly performing test kits that they have validated to measure tissue transglutaminase antibodies because all kits do not function to the same high standard. There remains a place for biopsy when criteria for serological diagnosis are not met, if the diagnosis of CD is strongly suspected but serological tests are negative or in patients not showing the expected responses to gluten free diet or otherwise causing concern, when not only small bowel biopsy will be indicated but also other investigations. Those with refractory CD should not be compromised by this diagnostic strategy. As serological tests become more refined and information accumulates, it is likely that this mode of diagnosis will gather momentum for the benefit of patients and carers. This brief review looks at the evidence for making the diagnosis of CD in some cases by serological tests alone.
高性能血清学检测方法的发展，使得能够识别乳糜泻（CD）患者，从而得以开展大规模筛查研究，其结果改变了我们对该疾病在普通人群中患病率的认识。接下来合乎逻辑的一步是，探究是否可以通过这些检测可靠地诊断CD，而无需进行小肠活检。事实证明的确如此。英国德比的研究表明，约一半的成年患者可以通过这种方式确诊，儿童的情况也类似。在考虑这种方法时，至关重要的是实验室仅使用经过验证可测量组织转谷氨酰胺酶抗体的高性能检测试剂盒，因为并非所有试剂盒都能达到同样高的标准。当血清学诊断标准未满足时，如果强烈怀疑患有CD但血清学检测呈阴性，或者患者对无麸质饮食未表现出预期反应或引发其他担忧，此时不仅需要进行小肠活检，还需进行其他检查，活检仍有其应用价值。难治性CD患者不应受此诊断策略的影响。随着血清学检测日益精细且信息不断积累，这种诊断模式可能会更具势头，造福患者及其护理人员。这篇简短综述探讨了仅通过血清学检测在某些情况下诊断CD的证据。
