Cvetkovic Lena, Bernard Gabriel, Galette Nathanaelle, Hétu Pierre-Olivier, Vincent Catherine, Bouin Mickael, Therrien Amelie
Department of Medicine - Division of Gastroenterology, Centre de recherche du Centre Hospitalier de l'Université de Montréal, Montréal, Québec, Canada.
Department of Biochemistry, Centre de recherche du Centre Hospitalier de l'Université de Montréal, Montréal, Québec, Canada.
J Can Assoc Gastroenterol. 2020 Aug;3(4):185-193. doi: 10.1093/jcag/gwz010. Epub 2019 Apr 22.
The liver and celiac disease (CeD) share a complex relationship. While in some patients, isolated hypertransaminasemia is the only manifestation of CeD, liver diseases (LD) may also be associated with the presence of isolated tissue transglutaminase antibodies IgA (tTG IgA) without histologic evidence of CeD.
To examine the yield of tTG IgA testing (a) in the workup for chronic liver disease (CLD) or cytolysis and (b) to identify biopsy-confirmed CeD (BxCeD) among patients with concomitant LD.
Retrospective study including two cohorts. Cohort 1 represented 444 consecutive individuals without known CeD for which liver specialists requested tTG IgA. Incidence of positive tTG and BxCeD was evaluated. Cohort 2 included 212 consecutive individuals with positive tTG IgA and subsequent duodenal biopsies. The frequency and clinical characteristics of individuals without BxCeD were examined, with and without concurrent LD.
The rate of first time positive tTG IgA among the tests requested by a liver specialist (cohort 1) was 2.0% ( = 9). However, 33.0% ( = 3) of these patients did not have BxCeD. Cohort 2 included 33 individuals with coexisting LD, of which 42.4% did not have BxCeD, compared with 16.2% of the patients without LD ( < 0.001). The majority of the patients without BxCeD (65.1%) showed an increase < 3 times upper limit of normal of tTG IgA.
Although there is clinical value in testing for CeD in the context of LD, there could be a high rate of positive CeD serology unaccompanied by histologic signs in patients with coexisting LD.
肝脏与乳糜泻（CeD）存在复杂的关系。在一些患者中，孤立性高转氨酶血症是CeD的唯一表现，而肝脏疾病（LD）也可能与孤立性组织转谷氨酰胺酶抗体IgA（tTG IgA）的存在相关，且无CeD的组织学证据。
研究tTG IgA检测（a）在慢性肝病（CLD）或细胞溶解检查中的阳性率，以及（b）在合并LD的患者中识别经活检确诊的CeD（BxCeD）。
回顾性研究包括两个队列。队列1为444例无已知CeD的连续个体，肝脏专科医生要求对其进行tTG IgA检测。评估tTG阳性和BxCeD的发生率。队列2包括212例tTG IgA阳性且随后进行十二指肠活检的连续个体。检查有无BxCeD的个体的频率和临床特征，无论是否合并LD。
肝脏专科医生要求检测的患者（队列1）中首次tTG IgA阳性率为2.0%（n = 9）。然而，这些患者中有33.0%（n = 3）没有BxCeD。队列2包括33例合并LD的个体，其中42.4%没有BxCeD，而无LD的患者中这一比例为16.2%（P < 0.001）。大多数没有BxCeD的患者（65.1%）tTG IgA升高<正常上限的3倍。
虽然在LD背景下检测CeD有临床价值，但在合并LD的患者中，CeD血清学阳性但无组织学征象的比例可能很高。
