Department of Pediatrics, Digestive Health Institute, School of Medicine, University of Colorado Anschutz Medical Campus, Aurora, Colorado, USA.
Barbara Davis Center for Diabetes, School of Medicine, University of Colorado Anschutz Medical Campus, Aurora, Colorado, USA.
Am J Gastroenterol. 2021 Jan 1;116(1):180-187. doi: 10.14309/ajg.0000000000000751.
The Autoimmunity Screening for Kids (ASK) study is a large scale pediatric screening study in Colorado for celiac disease (CD) and type 1 diabetes. This is a report of the CD outcomes for the first 9,973 children screened through ASK.
ASK screens children aged 1-17 years for CD using 2 highly sensitive assays for tissue transglutaminase autoantibodies (TGA): a radiobinding (RBA) assay for IgA TGA and an electrochemiluminescence (ECL) assay that detects all TGA isotypes. Children who test positive on either assay are asked to return for confirmatory testing. Those with a confirmed RBA TGA level ≥ 0.1 (twice the upper limit of normal) are referred to the Colorado Center for Celiac Disease for further evaluation; all others are referred to primary care.
Of the initial 9,973 children screened, 242 children were TGA+ by any assay. Of those initially positive, 185 children (76.4%) have completed a confirmation blood draw with 149 children (80.5%) confirming positive by RBA TGA. Confirmed RBA TGA+ was associated with a family history of CD (odds ratio [OR] = 1.83; 95% confidence interval 1.06-3.16), non-Hispanic white ethnicity (OR = 3.34; 2.32-4.79), and female sex (OR = 1.43; 1.03-1.98). Gastrointestinal symptoms of CD, assessed at the initial screening, were reported equally often among the RBA TGA+ vs TGA- children (32.1% vs 30.5%, P = 0.65).
The initial results of this ongoing mass-screening program confirm a high prevalence of undiagnosed CD autoimmunity in a screened US population. Symptoms at initial screening were not associated with TGA status (see Visual abstract, Supplementary Digital Content 5, http://links.lww.com/AJG/B587).
Autoimmunity Screening for Kids (ASK) 研究是科罗拉多州针对乳糜泻 (CD) 和 1 型糖尿病的一项大规模儿科筛查研究。这是通过 ASK 筛查的前 9973 名儿童中 CD 结果的报告。
ASK 使用两种针对组织转谷氨酰胺酶自身抗体 (TGA) 的高度敏感检测方法对 1-17 岁的儿童进行 CD 筛查：一种放射结合 (RBA) 测定 IgA TGA 和一种电化学发光 (ECL) 测定法，可检测所有 TGA 同种型。任何检测方法呈阳性的儿童都被要求返回进行确认性检测。那些 RBA TGA 水平≥0.1（正常值上限的两倍）的人被转介到科罗拉多乳糜泻中心进行进一步评估；所有其他患者均被转介至初级保健机构。
在最初筛查的 9973 名儿童中，有 242 名儿童的任何检测方法均呈 TGA+。在最初呈阳性的儿童中，有 185 名（76.4%）完成了确认性血液采集，其中 149 名（80.5%）通过 RBA TGA 确认阳性。RBA TGA+与 CD 的家族史（比值比 [OR] = 1.83；95%置信区间 1.06-3.16）、非西班牙裔白人种族（OR = 3.34；2.32-4.79）和女性性别（OR = 1.43；1.03-1.98）相关。在最初的筛查中评估的 CD 的胃肠道症状在 RBA TGA+和 TGA-儿童中同样常见（32.1%对 30.5%，P=0.65）。
这项正在进行的大规模筛查计划的初步结果证实，在筛查的美国人群中，未确诊的 CD 自身免疫存在较高的患病率。最初筛查时的症状与 TGA 状态无关（参见视觉摘要，补充数字内容 5，http://links.lww.com/AJG/B587）。
