Department of Gastroenterology, Hospital Universitari Mutua Terrassa, Terrassa, Spain.
Centro de Investigación Biomédica en Red de enfermedades hepáticas y digestivas (CIBERehd), Madrid, Spain.
Aliment Pharmacol Ther. 2020 Apr;51(7):699-705. doi: 10.1111/apt.15663. Epub 2020 Feb 12.
The causes of seronegative villous atrophy can be grouped as coeliac or noncoeliac related. There is no consensus on how to approach subjects with seronegative coeliac disease.
To evaluate the accuracy of both an increase in CD3 T-cell receptor gamma delta (TCRγδ ) intraepithelial lymphocytes and coeliac lymphogram for the diagnosis of coeliac disease in patients with seronegative villous atrophy.
Sixty-seven consecutive patients with seronegative villous atrophy were included. Duodenal biopsies to assess TCRγδ and CD3 by flow cytometry were performed at the index endoscopy. Coeliac lymphogram was defined as an increase in TCRγδ plus a decrease in CD3 intraepithelial lymphocytes. Sensitivity, specificity and Fagan's nomogram were calculated.
Coeliac disease was diagnosed in 37 patients and noncoeliac villous atrophy in 30. Coeliac patients were younger (39 ± 3 vs 55 ± 3 years; P = 0.001), more often showed HLA-DQ2/8 (97.6% vs 61%; P = 0.002) and had a more severe histology (61% vs 32% Marsh 3b-c; P = 0.055), as compared to noncoeliac ones. Coeliac lymphogram was associated with a sensitivity of 87% (CI, 73.7-95) and specificity of 96.7% (82.7-99.9), whereas evaluating only TCRγδ yielded a sensitivity of 91.3% (79.2-97.6) and specificity of 83.3% (65.3-94.3). Among patients with a pre-test coeliac disease probability of 30%, post-test probabilities were 92% and 5% for positive and negative coeliac lymphogram, and 70% and 4% for positive and negative TCRγδ .
Coeliac lymphogram was associated with a high level of diagnostic evidence either against or in favour of coeliac disease in patients with seronegative villous atrophy.
血清阴性绒毛萎缩的病因可分为乳糜泻相关和非乳糜泻相关。对于血清阴性乳糜泻患者，目前尚无共识如何进行处理。
评估 CD3 T 细胞受体 γδ（TCRγδ）上皮内淋巴细胞增加和乳糜泻淋巴图对血清阴性绒毛萎缩患者乳糜泻的诊断准确性。
纳入 67 例连续血清阴性绒毛萎缩患者。在首次内镜检查时进行十二指肠活检，以通过流式细胞术评估 TCRγδ 和 CD3。乳糜泻淋巴图定义为 TCRγδ 增加和 CD3 上皮内淋巴细胞减少。计算敏感性、特异性和 Fagan 列线图。
37 例患者诊断为乳糜泻，30 例为非乳糜泻绒毛萎缩。乳糜泻患者更年轻（39±3 岁比 55±3 岁；P=0.001），更常出现 HLA-DQ2/8（97.6%比 61%；P=0.002），且组织学更严重（61%比 32%Marsh 3b-c；P=0.055）。与非乳糜泻患者相比，乳糜泻淋巴图的敏感性为 87%（73.7-95），特异性为 96.7%（82.7-99.9），而仅评估 TCRγδ 的敏感性为 91.3%（79.2-97.6），特异性为 83.3%（65.3-94.3）。在乳糜泻疾病先验概率为 30%的患者中，乳糜泻淋巴图阳性和阴性的后验概率分别为 92%和 5%，TCRγδ 阳性和阴性的后验概率分别为 70%和 4%。
血清阴性绒毛萎缩患者中，乳糜泻淋巴图对诊断乳糜泻有较高的证据水平，无论是支持还是排除乳糜泻。
