Gastroenterology Department, Hospital Británico de Buenos Aires, Perdriel 74 (1012), Buenos Aires, Argentina.
Biochemistry Department, Hospital Británico de Buenos Aires, Buenos Aires, Argentina.
Dig Dis Sci. 2022 Apr;67(4):1238-1243. doi: 10.1007/s10620-021-06939-x. Epub 2021 Mar 26.
Guidelines for celiac disease (CD) testing recommend total serum IgA determination alongside anti-transglutaminase IgA antibodies. It is not well known if lack of serum IgA determination is a common finding in clinical practice.
To determine the prevalence of lack of serum IgA determination among patients screened for celiac disease.
We identified all subjects who underwent serum anti-transglutaminase IgA and/or other CD-related antibodies determination at a single teaching hospital in Buenos Aires from October 2019 to February 2020. Medical records were reviewed to select adult patients who were tested for celiac disease. The primary outcome was the proportion of patients with inadequate testing for celiac disease due to lack of serum IgA determination. We retrieved the following variables from each patient's record: age, gender, body mass index, symptoms present at screening, first-grade family history of CD, history of type-1 diabetes mellitus, autoimmune hypothyroidism, Down's syndrome.
Overall, 1122 patients were included for analysis. Lack of serum IgA determination prevalence was 20.49%. Among patients who did have serum IgA determination, the prevalence of IgA deficiency was 5.16%. The following variables were independently associated with a significantly increased odds of serum IgA determination: diarrhea [OR 1.55 (1.01-2.34)] and abdominal pain [OR 2.28 (1.44-3.63)]; higher body mass index [OR 0.91 (0.85-0.98)], osteoporosis [OR 0.49 (0.28-0.89)], hypothyroidism [OR 0.18 (0.07-0.45)], arthralgia/arthritis [OR 0.47 (0.27-0.85)], or testing by endocrinologist [OR 0.46 (0.23-0.91)] and gynecologist [OR 0.14 (0.06-0.31)] were inversely associated.
IgA deficiency is not systematically ruled out in a relatively high proportion of patients undergoing serological screening of celiac disease.
针对乳糜泻（CD）检测的指南建议同时测定血清总 IgA 与抗转谷氨酰胺酶 IgA 抗体。目前尚不清楚在临床实践中缺乏血清 IgA 测定是否是一种常见现象。
确定在接受乳糜泻筛查的患者中缺乏血清 IgA 测定的患病率。
我们在布宜诺斯艾利斯的一家教学医院确定了 2019 年 10 月至 2020 年 2 月期间进行血清抗转谷氨酰胺酶 IgA 和/或其他 CD 相关抗体检测的所有患者。回顾病历，选择接受乳糜泻检测的成年患者。主要结局是由于缺乏血清 IgA 测定而导致的乳糜泻检测不足的患者比例。我们从每位患者的记录中提取以下变量：年龄、性别、体重指数、筛查时的症状、一级亲属 CD 病史、1 型糖尿病病史、自身免疫性甲状腺功能减退症、唐氏综合征。
总体而言，有 1122 例患者被纳入分析。缺乏血清 IgA 测定的患病率为 20.49%。在进行了血清 IgA 测定的患者中，IgA 缺乏症的患病率为 5.16%。以下变量与血清 IgA 测定的可能性显著增加独立相关：腹泻[比值比 1.55（1.01-2.34）]和腹痛[比值比 2.28（1.44-3.63）]；较高的体重指数[比值比 0.91（0.85-0.98）]、骨质疏松症[比值比 0.49（0.28-0.89）]、甲状腺功能减退症[比值比 0.18（0.07-0.45）]、关节痛/关节炎[比值比 0.47（0.27-0.85）]，或由内分泌科医生[比值比 0.46（0.23-0.91）]和妇科医生[比值比 0.14（0.06-0.31）]进行的检测。
在接受乳糜泻血清学筛查的患者中，相当一部分患者并未系统地排除 IgA 缺乏症。
