Burgueño Gómez Beatriz, Escudero-Hernández Celia, de Pedro Rodrigo, Montalvillo Enrique, Bernardo David, García-Lagarto Elena, Garrote Adrados José Antonio, Arranz Sanz Eduardo, Fernández Salazar Luis
Servicio de Aparato Digestivo, Hospital Clínico Universitario de Valladolid, España.
Department of Clinical and Experimental Medicine, Linköping University, Sweden.
Rev Esp Enferm Dig. 2020 Jun;112(6):434-439. doi: 10.17235/reed.2020.6391/2019.
celiac disease (CD) patients have a specific pattern of lymphocytic infiltrate in the duodenal mucosa. Flow cytometry is a complementary tool for the diagnosis of CD, which allows the quantification and characterization of intraepithelial lymphocytes (IELs) by what is commonly called a lymphogram. Here we describe our experience with this technique in the diagnosis of CD in adult patients.
lymphograms from 157 patients performed in our center between 2009 and 2017 were retrospectively analyzed. Fourteen patients had a previous diagnosis of CD and followed a gluten-free diet (GFD), 21 had a new diagnosis of CD and the remaining were considered as non-celiac. The association of the lymphogram results (total IELs, CD3- lymphocytes and TcRγδ lymphocytes) with the CD diagnosis, compliance with the GFD, time since diagnosis and IgA anti-TG2 titer were determined.
the area under the ROC curve of TcRγδ lymphocytes for CD patients varied between 0.86 and 0.86. The percentage of TcRγδ lymphocytes in GFD-treated patients was lower; 12 (8.5) vs 20.5 (8.7), p = 0.0153. However, it remained high compared to non-CD; 12 (8.5) vs 6.7 (6), p = 0.135. The time since diagnosis and IgA anti-TG2 titer correlated with the lymphogram results. Helicobacter pylori infection and treatment with angiotensin receptor antagonist 2 (ARA2) were associated with differences in the lymphogram results in patients without CD.
the duodenal lymphogram is a reliable complementary tool in adults for the diagnosis of CD. However, compliance and duration of the GFD and other factors may condition its diagnostic capacity.
乳糜泻（CD）患者十二指肠黏膜存在特定模式的淋巴细胞浸润。流式细胞术是诊断CD的一种辅助工具，它可以通过通常所说的淋巴细胞图对上皮内淋巴细胞（IELs）进行定量和特征分析。在此，我们描述了我们在成年患者CD诊断中应用该技术的经验。
回顾性分析了2009年至2017年在我们中心进行的157例患者的淋巴细胞图。14例患者先前已诊断为CD并遵循无麸质饮食（GFD），21例为新诊断的CD患者，其余患者被视为非乳糜泻患者。确定淋巴细胞图结果（总IELs、CD3 - 淋巴细胞和TcRγδ淋巴细胞）与CD诊断、GFD依从性、诊断后的时间以及IgA抗TG2滴度之间的关联。
CD患者的TcRγδ淋巴细胞的ROC曲线下面积在0.86至0.86之间变化。接受GFD治疗的患者中TcRγδ淋巴细胞的百分比更低；分别为12（8.5）对20.5（8.7），p = 0.0153。然而，与非CD患者相比，其比例仍然较高；分别为12（8.5）对6.7（6），p = 0.135。诊断后的时间和IgA抗TG2滴度与淋巴细胞图结果相关。幽门螺杆菌感染和血管紧张素受体拮抗剂2（ARA2）治疗与非CD患者的淋巴细胞图结果差异有关。
十二指肠淋巴细胞图是成人诊断CD的可靠辅助工具。然而，GFD的依从性和持续时间以及其他因素可能会影响其诊断能力。
