From the Hospital Universitario y Politécnico La Fe, Valencia, Spain.
the Unidad de Enfermedad Celiaca e Inmunopatología Digestiva, Instituto de Investigación Sanitaria La Fe, Valencia, Spain.
J Pediatr Gastroenterol Nutr. 2022 Dec 1;75(6):743-748. doi: 10.1097/MPG.0000000000003620. Epub 2022 Sep 20.
The objective of this study was to assess the association between serological markers and changes of the intestinal mucosa in children with celiac disease (CD).
Clinical data from CD patients under 15 years old were collected from the participating centers in an on-line multicenter nationwide observational Spanish registry called REPAC-2 (2011-2017). Correlation between anti-tissue transglutaminase antibodies (t-TGA) levels and other variables, including mucosal damage and clinical findings (symptoms, age, and gender), was assessed.
A total of 2955 of 4838 patients had t-TGA and a small bowel biopsy (SBB) performed for CD diagnosis. A total of 1931 (66.2%) patients with normal IgA values had a Marsh 3b-c lesion and 1892 (64.9%) had t-TGA Immunoglobulin A (IgA) ≥ 10 times upper limit of normal (ULN). There is a statistically significant association between t-TGA IgA levels and the degree of mucosal damage ( P < 0.001), the higher the t-TGA IgA levels the more severe the mucosal damage. Those patients who reported symptoms had more severe mucosal damage ( P = 0.001). On the contrary, there was a negative association between age and changes of the intestinal mucosa ( P < 0.001). No association was found with gender. Regarding the IgA-deficient patients, 47.4% (18 cases) had t-TGA Immunoglobulin A (IgA) ≥ 10 times ULN and a Marsh 3b-c lesion was observed in 68.4% (26 patients). No statistical relation was found between t-TGA IgG levels and the changes of the intestinal mucosa, neither a relation with age, gender, or symptoms.
There is a positive correlation between t-TGA IgA levels and the severity of changes of the intestinal mucosa. Such correlation was not found in IgA-deficient patients who had positive t-TGA IgG serology. The results in this group of patients support the European Society for Paediatric Gastroenterology, Hepatology, and Nutrition recommendations about the need of performing a SBB in IgA-deficient individuals despite high t-TGA IgG levels.
本研究旨在评估乳糜泻（CD）患儿血清标志物与肠黏膜变化之间的关系。
本研究收集了参加西班牙全国多中心在线观察性研究 REPAC-2（2011-2017 年）的各中心的 15 岁以下 CD 患儿的临床资料。评估了抗组织转谷氨酰胺酶抗体（t-TGA）水平与其他变量（包括黏膜损伤和临床发现[症状、年龄和性别]）之间的相关性。
共有 4838 例患者中的 2955 例进行了 t-TGA 和小肠活检（SBB）以诊断 CD。2955 例患者中，1931 例（66.2%）IgA 值正常者有 Marsh 3b-c 病变，1892 例（64.9%）t-TGA 免疫球蛋白 A（IgA）≥10 倍正常值上限（ULN）。t-TGA IgA 水平与黏膜损伤程度呈显著正相关（P <0.001），t-TGA IgA 水平越高，黏膜损伤越严重。有症状的患者黏膜损伤更严重（P =0.001）。相反，年龄与肠黏膜变化呈负相关（P <0.001）。性别与肠黏膜变化无相关性。对于 IgA 缺乏的患者，47.4%（18 例）t-TGA 免疫球蛋白 A（IgA）≥10 倍 ULN，68.4%（26 例）出现 Marsh 3b-c 病变。未发现 t-TGA IgG 水平与肠黏膜变化之间存在相关性，也未发现与年龄、性别或症状之间存在相关性。
t-TGA IgA 水平与肠黏膜变化的严重程度呈正相关。在 t-TGA IgG 血清学阳性但 IgA 缺乏的患者中未发现这种相关性。这组患者的结果支持欧洲儿科学会胃肠病学、肝病学和营养学会的建议，即对于 t-TGA IgG 水平高但 IgA 缺乏的个体，仍需进行 SBB。
