Wang M, Lu J J, Li T, Ma C T, Li Z Q, Abudurexiti Adilai, Hui W J, Wang C, Sun Z Z, Gao F
Graduate School of Xinjiang Medical University, Urumqi 830001, China.
Department of Gastroenterology, People's Hospital of Xinjiang Uygur Autonomous Region, Urumqi 830001, China Xinjiang Clinical Research Center for Digestive Diseases, Urumqi 830001, China.
Zhonghua Nei Ke Za Zhi. 2023 Feb 1;62(2):188-192. doi: 10.3760/cma.j.cn112138-20220220-00127.
To evaluate the association between serum anti-tissue transglutaminase antibody (anti-tTG) titers and the severity of histological damage to the duodenal mucosa and to predict a possible anti-tTG cutoff value for diagnosing celiac disease (CD) and villous atrophy in the domestic population. Clinical and pathological data from 76 adult CD patients with positive anti-tTG titers and duodenal biopsy results who were treated at the People's Hospital of Xinjiang Uygur Autonomous Region from July 2017 to January 2022 were retrospectively analyzed. The correlation between anti-tTG titers and the severity of duodenal mucosal damage was statistically assessed to predict the optimal anti-tTG titer cut-off value for diagnosing CD and villous atrophy. Of the 76 patients, 10 had underlying CD, and of the 66 patients with duodenal histopathology, four were Marsh Ⅰ, six were Marsh Ⅱ, and 56 were Marsh Ⅲa-c grade. In adults with CD, anti-tTG titers were shown to be associated with the severity of histological damage to the duodenal mucosa. When the anti-tTG level was ≥5 times the upper limit of normal (ULN), the sensitivity and specificity for diagnosing CD were 83.9% and 92.9%, respectively. When the anti-tTG titer was ≥8 times the ULN, the sensitivity and specificity for diagnosing villous atrophy were 67.9% and 90.0%, respectively. Anti-tTG levels had a strong predictive value for diagnosing CD in adults when titers exceeded 10 times the ULN. Thus, the anti-tTG cut-off value can be combined with clinical judgment to diagnose CD, limiting the use of invasive endoscopy.
评估血清抗组织转谷氨酰胺酶抗体（抗tTG）滴度与十二指肠黏膜组织学损伤严重程度之间的关联，并预测国内人群诊断乳糜泻（CD）和绒毛萎缩的抗tTG临界值。回顾性分析2017年7月至2022年1月在新疆维吾尔自治区人民医院接受治疗的76例抗tTG滴度阳性且有十二指肠活检结果的成年CD患者的临床和病理数据。对抗tTG滴度与十二指肠黏膜损伤严重程度之间的相关性进行统计学评估，以预测诊断CD和绒毛萎缩的最佳抗tTG滴度临界值。76例患者中，10例有潜在CD，在66例有十二指肠组织病理学检查的患者中，4例为马什Ⅰ级，6例为马什Ⅱ级，56例为马什Ⅲa - c级。在成年CD患者中，抗tTG滴度与十二指肠黏膜组织学损伤严重程度相关。当抗tTG水平≥正常上限（ULN）的5倍时，诊断CD的敏感性和特异性分别为83.9%和92.9%。当抗tTG滴度≥ULN的8倍时，诊断绒毛萎缩的敏感性和特异性分别为67.9%和90.0%。当抗tTG滴度超过ULN的10倍时，抗tTG水平对诊断成年CD具有较强的预测价值。因此，抗tTG临界值可与临床判断相结合来诊断CD，限制侵入性内镜检查的使用。
