Department of Gastroenterology, Hospital Universitari Mutua Terrassa, Terrassa, Barcelona, Spain.
Centro de Investigación Biomédica en Red de Enfermedades Hepáticas y Digestivas (CIBERehd), Instituto de Salud Carlos III, Madrid, Spain.
BMC Med. 2021 Oct 6;19(1):237. doi: 10.1186/s12916-021-02116-z.
The diagnosis of coeliac disease (CD) in individuals that have started a gluten-free diet (GFD) without an adequate previous diagnostic work-out is a challenge. Several immunological assays such as IFN-γ ELISPOT have been developed to avoid the need of prolonged gluten challenge to induce the intestinal damage. We aimed to evaluate the diagnostic accuracy of activated gut-homing CD8 and TCRγδ T cells in blood after a 3-day gluten challenge and to compare it with the performance of IFN-γ ELISPOT in a HLA-DQ2.5 subsample.
A total of 22 CD patients and 48 non-CD subjects, all of them following a GFD, underwent a 3-day 10-g gluten challenge. The percentage of two T cell subsets (CD8 CD103 β7 CD38/total CD8 and TCRγδ CD103 β7 CD38/total TCRγδ) in fresh peripheral blood drawn baseline and 6 days after the challenge was determined by flow cytometry. IFN-γ ELISPOT assays were also performed in HLA-DQ2.5 participants. ROC curve analysis was used to assess the diagnostic performance of the CD8 T cell response and IFN-γ ELISPOT.
Significant differences between the percentage of the two studied subsets of CD8 and TCRγδ cells at days 0 and 6 were found only when considering CD patients (p < 10 vs. non-CD subjects). Measuring activated CD8 T cells provided accurate CD diagnosis with 95% specificity and 97% sensitivity, offering similar results than IFN-γ ELISPOT.
The results provide a highly accurate blood test for CD diagnosis in patients on a GFD of easy implementation in daily clinical practice.
在没有充分先前诊断的情况下，开始无麸质饮食（GFD）的个体中，乳糜泻（CD）的诊断具有挑战性。已经开发了几种免疫测定方法，例如 IFN-γ ELISPOT，以避免需要延长谷蛋白挑战来诱导肠损伤。我们旨在评估在 3 天谷蛋白挑战后血液中活化的肠道归巢 CD8 和 TCRγδ T 细胞的诊断准确性，并在 HLA-DQ2.5 亚样本中比较其与 IFN-γ ELISPOT 的性能。
总共 22 例 CD 患者和 48 例非 CD 患者，均遵循 GFD，进行了为期 3 天的 10 克谷蛋白挑战。在基线和挑战后第 6 天通过流式细胞术测定新鲜外周血中两种 T 细胞亚群（CD8 CD103 β7 CD38/总 CD8 和 TCRγδ CD103 β7 CD38/总 TCRγδ）的百分比。还在 HLA-DQ2.5 参与者中进行了 IFN-γ ELISPOT 测定。使用 ROC 曲线分析评估 CD8 T 细胞反应和 IFN-γ ELISPOT 的诊断性能。
仅当考虑 CD 患者时，才发现 CD8 和 TCRγδ 细胞的两个研究亚群在第 0 天和第 6 天之间的百分比存在显著差异（p <10 与非 CD 受试者）。测量活化的 CD8 T 细胞提供了具有 95%特异性和 97%敏感性的准确 CD 诊断，与 IFN-γ ELISPOT 提供的结果相似。
这些结果为 GFD 患者的 CD 诊断提供了一种易于在日常临床实践中实施的高度准确的血液检测。
