Section of Gastroenterology, Department of Emergency and Organ Transplantation, University "Aldo Moro" of Bari, 70124 Bari, Italy.
Ph.D. Course in Organs and Tissues Transplantation and Cellular Therapies, Department of Emergency and Organ Transplantation, University "Aldo Moro" of Bari, 70124 Bari, Italy.
Medicina (Kaunas). 2021 Nov 5;57(11):1212. doi: 10.3390/medicina57111212.
: Pediatric guidelines on celiac disease (CD) state that children with anti-transglutaminase antibodies (TGAs) >×10 upper limit of normal (ULN) may avoid endoscopy and biopsy. We aimed to evaluate whether these criteria may be suitable for villous atrophy diagnosis in CD adults. : We retrospectively enrolled patients with CD aged >18 years. TGAs were expressed as xULN. Duodenal lesions were classified as atrophic or non-atrophic according to Marsh-Oberhuber. Fisher's exact and -test were used for variables comparison. Receiver operating characteristics (ROC) curve analysis was performed with estimation of area under the curve (AUC), sensitivity, specificity, and positive and negative predictive value (PPV/NPV). One hundred and twenty-one patients were recruited. Sixty patients (49.6%) had TGA >×10 ULN, and 93 (76.8%) had villous atrophy. The cut-off of >×10 ULN had sensitivity = 53.7%, specificity = 64.3%, PPV = 83.3%, and NPV = 29.5% to predict atrophy. Therefore, considering pediatric criteria, in 50 (41.3%) patients, biopsy could have been avoided. Patient subgroup with atrophy had higher TGA levels despite being not significant (37.2 ± 15.3 vs. 8.0 ± 1.3 ULN, = 0.06). In adults, a slightly better diagnostic performance was obtained using a cut-off of TGA >×6.2 ULN (sensitivity = 57.1%, specificity = 65.6%, and AUC = 0.62). Despite our confirmation that villous atrophy is linked to high TGA levels, CD and atrophy diagnosis based only on serology is not reliable in adults.
: 儿科腹腔疾病（CD）指南指出，抗转谷氨酰胺酶抗体（TGAs）>×10 上限正常（ULN）的儿童可能无需进行内镜和活检。我们旨在评估这些标准是否适用于 CD 成人的绒毛萎缩诊断。 : 我们回顾性纳入了年龄>18 岁的 CD 患者。TGAs 以 xULN 表示。根据 Marsh-Oberhuber 对十二指肠病变进行萎缩或非萎缩分类。Fisher 确切检验和 t 检验用于变量比较。采用受试者工作特征（ROC）曲线分析，评估曲线下面积（AUC）、敏感性、特异性、阳性和阴性预测值（PPV/NPV）。 共纳入 121 例患者。60 例（49.6%）TGA>×10 ULN，93 例（76.8%）有绒毛萎缩。>×10 ULN 的截断值预测萎缩的敏感性为 53.7%，特异性为 64.3%，PPV 为 83.3%，NPV 为 29.5%。因此，考虑儿科标准，50 例（41.3%）患者可避免进行活检。尽管无统计学意义，但萎缩患者的 TGA 水平更高（37.2±15.3 与 8.0±1.3 ULN，=0.06）。在成人中，使用 TGA >×6.2 ULN 的截断值可获得略好的诊断性能（敏感性为 57.1%，特异性为 65.6%，AUC 为 0.62）。 尽管我们证实绒毛萎缩与高 TGA 水平有关，但仅基于血清学诊断 CD 和萎缩在成人中不可靠。
