采用微创生物标志物评估西班牙儿科人群中的乳糜泻。
Evaluation of Celiac Disease by Minimally Invasive Biomarkers in a Spanish Pediatric Population.
机构信息
Clinical Analysis Laboratory, Department of Inmunology, Hospital Universitario Lucus Augusti, 27003 Lugo, Spain.
Doctoral Programme in Medicine Clinical Research, International PhD School of the University of Santiago de Compostela (EDIUS), 15782 Santiago de Compostela, Spain.
出版信息
Int J Environ Res Public Health. 2022 Apr 20;19(9):5020. doi: 10.3390/ijerph19095020.
BACKGROUND
The diagnosis of celiac disease (CD) has been substantially improved with the availability of highly sensitive CD-specific IgA-TG2, Ig-GDP, and IgA-EMA. The European Society for Pediatric Gastroenterology, Hepatology, and Nutrition (ESPGHAN) published (2012) and updated (2020) diagnostic criteria for CD in order to simplify CD diagnosis and to avoid biopsies in selected patients.
METHODS
A prospective study including 5641 pediatric patients (0-16 years old) from January 2012 to January 2019 was performed. CD diagnosis was made according to the ESPGHAN algorithm. The objective of this study was to evaluate the utility of biomarkers and the relationship between TGA-IgA and EMA titers.
RESULTS
CD diagnoses were confirmed in 113 patients, 110 were IgA-TG2-positive and 3 (2.7%) had IgA deficiency. The diagnosis was made by serologic tests in 95 (84.1%) patients. Only 18 (15.9%) patients underwent intestinal biopsy. We obtained 100% concordance between IgA-EMA and positive results for IgA-TG2 ≥ 10 ULN with IgA-EMA antibody titer ≥ 1:80.
CONCLUSIONS
This study provides evidence of a positive correlation between IgA-TG2 antibody serum levels and IgA-EMA. The diagnosis could be guaranteed with strict application of IgA-TG2 values ≥ 10 ULN (confirmed by subsequent testing) plus the serological response to the gluten-free diet (GFD).
背景
随着高度敏感的针对乳糜泻的 IgA-TG2、Ig-GDP 和 IgA-EMA 的出现，乳糜泻（CD）的诊断得到了极大的改善。为了简化 CD 的诊断并避免在特定患者中进行活检，欧洲儿科胃肠病学、肝病学和营养学会（ESPGHAN）于 2012 年和 2020 年发布并更新了 CD 的诊断标准。
方法
一项包括 5641 名儿科患者（0-16 岁）的前瞻性研究于 2012 年 1 月至 2019 年 1 月进行。根据 ESPGHAN 算法进行 CD 诊断。本研究的目的是评估生物标志物的实用性以及 TGA-IgA 和 EMA 滴度之间的关系。
结果
确诊 CD 患儿 113 例，其中 110 例 IgA-TG2 阳性，3 例（2.7%）存在 IgA 缺乏。95 例（84.1%）患儿通过血清学检测进行诊断。仅 18 例（15.9%）患儿进行了肠道活检。我们发现 IgA-EMA 和 IgA-TG2 抗体滴度≥10ULN（通过后续检测确认）阳性与 IgA-EMA 抗体滴度≥1:80 之间具有 100%的一致性。
结论
本研究提供了 IgA-TG2 抗体血清水平与 IgA-EMA 之间存在正相关的证据。通过严格应用 IgA-TG2 值≥10ULN（通过后续检测确认）加上对无麸质饮食（GFD）的血清学反应，可以保证诊断的准确性。
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