Paul Siba Prosad, Raja Daniyal Isam, Sandhu Bhupinder Kaur, Rao Srinivasa R, Spray Christine H, Wiskin Anthony Edward, Selvarajan Lakshmipriya, Volonaki Eleni, Ramani Pramila, Tashtoush Lina Bourhan, Basude Dharamveer
Paediatric Gastroenterology, Bristol Royal Hospital for Children, Bristol, UK
Paediatrics, Yeovil District Hospital, Yeovil, UK.
Arch Dis Child. 2022 Aug;107(8):747-751. doi: 10.1136/archdischild-2021-322000. Epub 2022 Feb 16.
European Society for Paediatric Gastroenterology Hepatology and Nutrition (ESPGHAN) guidelines on coeliac disease (CD) recommend that children who have IgA-based antitissue transglutaminase (TGA-IgA) titre ≥10× upper limit of normal (ULN) and positive antiendomysial antibody, can be reliably diagnosed with CD via the no-biopsy pathway. The aim of this study was to examine the relationship between TGA-IgA ≥5×ULN and histologically confirmed diagnosis of CD.
Data including TGA-IgA levels at upper gastrointestinal endoscopy and histological findings from children diagnosed with CD following endoscopy from 2006 to 2021 were analysed. CD was confirmed by Marsh-Oberhuber histological grading 2 to 3 c. Statistical analysis was performed using χ² analysis (p<0.05= significant).
722 of 758 children had histological confirmation of CD. 457 children had TGA-IgA ≥5×ULN and 455 (99.5%) of these had histological confirmation for CD; the two that did not had eventual diagnosis of CD based on clinicopathological features. 114 of 457 had between TGA-IgA ≥5×ULN and <10×ULN, all had confirmed CD. The likelihood of a positive biopsy with TGA-IgA ≥5×ULN (455/457) compared with TGA-IgA <5×ULN (267/301) has strong statistical significance (p<0.00001). The optimal TGA-IgA cut-off from receiver operating characteristic curve analysis was determined to be below 5×ULN for the two assays used.
99.5% of children with TGA-IgA ≥5×ULN had histological confirmation of CD, suggesting that CD diagnosis can be made securely in children with TGA-IgA ≥5×ULN. If other studies confirm this finding, there is a case to be made to modify the ESPGHAN guidelines to a lower threshold of TGA-IgA for serological diagnosis of CD.
欧洲儿科胃肠病、肝病和营养学会（ESPGHAN）关于乳糜泻（CD）的指南建议，基于免疫球蛋白A的抗组织转谷氨酰胺酶（TGA-IgA）滴度≥正常上限（ULN）的10倍且抗肌内膜抗体呈阳性的儿童，可通过非活检途径可靠地诊断为CD。本研究的目的是探讨TGA-IgA≥5×ULN与经组织学证实的CD诊断之间的关系。
分析2006年至2021年期间接受上消化道内镜检查并被诊断为CD的儿童的TGA-IgA水平及内镜检查后的组织学检查结果等数据。CD通过Marsh-Oberhuber组织学分级2至3c确诊。采用χ²分析进行统计学分析（p<0.05为有统计学意义）。
758名儿童中有722名经组织学证实为CD。457名儿童的TGA-IgA≥5×ULN，其中455名（99.5%）经组织学证实为CD；另外两名根据临床病理特征最终诊断为CD。457名中有114名儿童的TGA-IgA在≥5×ULN且<10×ULN之间，均确诊为CD。TGA-IgA≥5×ULN（455/457）时活检阳性的可能性与TGA-IgA<5×ULN（267/301）相比具有很强的统计学意义（p<0.00001）。通过受试者工作特征曲线分析确定，所使用的两种检测方法的最佳TGA-IgA临界值均低于5×ULN。
99.5%的TGA-IgA≥5×ULN的儿童经组织学证实为CD，这表明TGA-IgA≥5×ULN的儿童可以可靠地诊断为CD。如果其他研究证实这一发现，则有理由将ESPGHAN指南中CD血清学诊断的TGA-IgA阈值下调。
