麸质敏感患儿中脱酰胺麦胶蛋白肽和组织转谷氨酰胺酶抗体：相关性研究。

Deamidated gliadin peptide and tissue transglutaminase antibodies in children with coeliac disease: A correlation study.

机构信息

Department of Pediatrics, Faculty of Medicine, King Abdulaziz University, Jeddah, Saudi Arabia.

Deparrtment of Pediatrics, East Jeddah General Hospital, Jeddah, Saudi Arabia.

出版信息

Arab J Gastroenterol. 2020 Sep;21(3):174-178. doi: 10.1016/j.ajg.2020.07.001. Epub 2020 Jul 28.

DOI:10.1016/j.ajg.2020.07.001

PMID:32732170

Abstract

BACKGROUND AND STUDY AIMS

Serological tests for coeliac disease (CD) are important in the clinical diagnosis and monitoring of response to a gluten free diet (GFD). The tests differ in their sensitivity, specificity, and diagnostic accuracy. In this study, tissue transglutaminase (IgA) (tTG-IgA) antibody was compared with the deamidated gliadin peptide (DGP), of both IgG (DGP-IgG) and IgA (DGP-IgA) types, in patients with CD.

PATIENTS AND METHODS

This cross-sectional study was conducted over a period of 2 years, between 2016 and 2018, at King Abdulaziz University Hospital in children 18 years of age or younger with biopsy-proven CD. Patients' sera were tested for DGP-IgA, DGP-IgG, and tTG-IgA antibodies using enzyme-linked immunosorbent assay (ELISA). A Pearson correlation coefficient and Cohen's kappa coefficient were performed to analyse the serological tests.

RESULTS

The study included 26 patients with CD, with a median age of 15 years (range, 5-18 years). Seventeen patients (65.4%) were males. The median disease duration was 5 years (range, 3-14 years). Fifteen patients (57.7%) reported good adherence to a GFD. The patients' serological tests showed a mean ± SD tTG-IgA titer of 149.8 ± 75 u/ml, a mean DGP-IgG titer of 62.5 ± 36.5, and a mean DGP-IgA of 32 ± 23.3 μ/ml. We found a significant correlation between tTG-IgA and DGP-IgG (r = 0.69, P < 0.001), tTG-IgA and DGP-IgA (r = 0.67, P < 0.001), and DGP-IgG and DGP-IgA (r = 0.83, P < 0.001). Cohen's kappa coefficient (k) showed substantial agreement between tTG-IgA and DGP-IgG (k = 0.71, P < 0.001) and DGP-IgG and DGP-IgA (k = 0.69, P < 0.001), but moderate agreement between tTG-IgA and DGP-IgA (k = 0.45, P = 0.006).

CONCLUSION

We found a good correlation between tTG-IgA and DGP-IgG and tTG-IgA and DGP-IgA, and substantial agreement between tTG-IgA and DGP-IgG, but moderate agreement between tTG-IgA and DGP-IgA. These results indicate that DGP-IgG was comparable to tTG-IgA and may be useful as an alternative to tTG-IgA in the diagnosis and follow-up of patients with CD.

摘要

背景和研究目的

针对乳糜泻（CD）的血清学检测在临床诊断和监测无麸质饮食（GFD）的反应中非常重要。这些检测在灵敏度、特异性和诊断准确性方面存在差异。在这项研究中，我们比较了组织转谷氨酰胺酶（IgA）（tTG-IgA）抗体与脱酰胺麦胶肽（DGP），包括 IgG（DGP-IgG）和 IgA（DGP-IgA）两种类型，在 CD 患者中的应用。

患者和方法

这是一项横断面研究，在 2016 年至 2018 年期间，在阿卜杜勒阿齐兹国王大学医院对 18 岁以下经活检证实为 CD 的患者进行，检测患者血清中的 DGP-IgA、DGP-IgG 和 tTG-IgA 抗体，采用酶联免疫吸附试验（ELISA）进行检测。使用 Pearson 相关系数和 Cohen's kappa 系数来分析血清学检测结果。

结果

本研究纳入了 26 例 CD 患者，中位年龄为 15 岁（范围，5-18 岁）。17 例（65.4%）为男性。中位疾病持续时间为 5 年（范围，3-14 年）。15 例（57.7%）患者报告良好的 GFD 依从性。患者的血清学检测结果显示 tTG-IgA 滴度的平均值±标准差为 149.8±75 u/ml，DGP-IgG 滴度的平均值±标准差为 62.5±36.5，DGP-IgA 的平均值±标准差为 32±23.3 μ/ml。我们发现 tTG-IgA 与 DGP-IgG（r=0.69，P<0.001）、tTG-IgA 与 DGP-IgA（r=0.67，P<0.001）以及 DGP-IgG 与 DGP-IgA（r=0.83，P<0.001）之间存在显著相关性。Cohen's kappa 系数（k）显示 tTG-IgA 与 DGP-IgG（k=0.71，P<0.001）和 DGP-IgG 与 DGP-IgA（k=0.69，P<0.001）之间具有高度一致性，但 tTG-IgA 与 DGP-IgA（k=0.45，P=0.006）之间具有中度一致性。

结论

我们发现 tTG-IgA 与 DGP-IgG 和 tTG-IgA 与 DGP-IgA 之间存在良好的相关性，以及 tTG-IgA 与 DGP-IgG 之间存在高度一致性，但 tTG-IgA 与 DGP-IgA 之间存在中度一致性。这些结果表明 DGP-IgG 与 tTG-IgA 相当，可能是 CD 患者诊断和随访的替代检测方法。