Lenti Marco Vincenzo, Aronico Nicola, Giuffrida Paolo, Antoci Valentina, Santacroce Giovanni, Vanoli Alessandro, Klersy Catherine, Corazza Gino Roberto, Di Sabatino Antonio
Department of Internal Medicine, IRCCS San Matteo Hospital Foundation, University of Pavia, 27100 Pavia, Italy.
Anatomic Pathology Unit, IRCCS San Matteo Hospital Foundation, Department of Molecular Medicine, University of Pavia, 27100 Pavia, Italy.
Cancers (Basel). 2021 May 11;13(10):2289. doi: 10.3390/cancers13102289.
The persistence or recurrence of symptoms in patients with coeliac disease (CD), despite a gluten-free diet (GFD), must prompt further work-up for excluding refractory CD (RCD). The aim of this study was to assess the accuracy of serum markers in predicting refractoriness in CD patients. This study included 72 patients affected by CD followed-up at our center, namely 49 uncomplicated CD before and after GFD and 23 RCD. Serum levels of chromogranin A (CgA) and β2-microglobuline were measured at baseline and at follow-up (median time of 13 months) in each group of patients. Cut-off points for each marker were estimated to differentiate RCD from uncomplicated CD patients. Serum levels of CgA and β2-microglobuline were significantly higher in patients with RCD compared to uncomplicated CD ( < 0.001), both at baseline and at follow-up, with no significant difference between RCD type 1 and type 2. The estimated cut-off point for CgA was 90.2 ng/mL (sensitivity 83%, specificity 100%), while for β2-microglobuline it was 696 mcg/L (sensitivity 100%, specificity of 100%). To conclude, CgA and β2-microglobuline could be useful serological markers of refractoriness in CD, with the ability to discriminate those patients who should undergo upper gastrointestinal endoscopy for making a definite diagnosis.
患有乳糜泻（CD）的患者，尽管采用了无麸质饮食（GFD），但症状持续或复发，必须促使进一步检查以排除难治性乳糜泻（RCD）。本研究的目的是评估血清标志物在预测CD患者难治性方面的准确性。本研究纳入了在我们中心接受随访的72例CD患者，即49例GFD前后的非复杂性CD患者和23例RCD患者。在每组患者的基线和随访时（中位时间13个月）测量嗜铬粒蛋白A（CgA）和β2-微球蛋白的血清水平。估计每个标志物的截断点以区分RCD和非复杂性CD患者。与非复杂性CD患者相比，RCD患者的CgA和β2-微球蛋白血清水平在基线和随访时均显著更高（<0.001），1型和2型RCD之间无显著差异。CgA的估计截断点为90.2 ng/mL（敏感性83%，特异性100%），而β2-微球蛋白的估计截断点为696 mcg/L（敏感性100%，特异性100%）。总之，CgA和β2-微球蛋白可能是CD难治性的有用血清学标志物，能够区分那些应接受上消化道内镜检查以明确诊断的患者。
