不同医疗服务提供者类型的乳糜泻血清学检测差异：单中心经验
Variability in Celiac Serology Testing by Provider Type: A Single-Center Experience.
作者信息
Chugh Ankur, Lo Stanley F
机构信息
From the Section of Pediatric Gastroenterology, Hepatology, and Nutrition, Medical College of Wisconsin/Children's Hospital of Wisconsin, Milwaukee, WI.
Department of Pathology, Medical College of Wisconsin/Children's Hospital of Wisconsin, Milwaukee, WI.
出版信息
JPGN Rep. 2023 Mar 24;4(2):e302. doi: 10.1097/PG9.0000000000000302. eCollection 2023 May.
UNLABELLED
To evaluate the ordering practices of celiac disease (CD) serologies by providers at a tertiary, academic, Children's Hospital and compare them to guidelines and best practices.
METHODS
We analyzed celiac serologies ordered in 2018 by provider type (pediatric gastrointestinal (GI) specialists, primary care providers (PCPs), and nonpediatric GI specialists), and identified causes for variability and nonadherence.
RESULTS
The antitissue transglutaminase antibody (tTG) IgA was ordered (n = 2504) most frequently by gastroenterologists (43%), endocrinologists (22%), and other (35%). Total IgA was ordered with tTG IgA for screening purposes in 81% of overall cases, but endocrinologists ordered it only 49% of the time. The tTG IgG was ordered infrequently (1.9%) compared with tTG IgA. Antideaminated gliadin peptide (DGP) IgA/IgG levels were also infrequently ordered (5.4%) compared with tTG IgA. The antiendomysial antibody was ordered sparingly (0.9%) compared with tTG IgA, but appropriately by providers with expertise in CD, similar to ordering for celiac genetics (0.8%). Of the celiac genetic tests, 15% were ordered in error. The positivity rate of the tTG IgA ordered by PCPs was 4.4%.
CONCLUSIONS
The tTG IgA was appropriately ordered by all types of providers. Endocrinologists inconsistently ordered total IgA levels with screening labs. DGP IgA/IgG tests were not commonly ordered but were inappropriately ordered by one provider. The low number of ordered antiendomysial antibody and celiac genetic tests suggests under-utilization of the nonbiopsy approach. The positive yield of tTG IgA ordered by PCPs was higher compared with previous studies.
未标注
评估一家三级学术儿童医院的医疗服务提供者对乳糜泻（CD）血清学检查的开具情况，并将其与指南和最佳实践进行比较。
方法
我们分析了2018年按医疗服务提供者类型（儿科胃肠病（GI）专科医生、初级保健提供者（PCP）和非儿科GI专科医生）开具的乳糜泻血清学检查，并确定了变异性和不依从性的原因。
结果
抗组织转谷氨酰胺酶抗体（tTG）IgA的开具次数最多（n = 2504），胃肠病学家开具的比例为43%，内分泌学家为22%，其他为35%。在81%的总体病例中，为筛查目的，总IgA与tTG IgA一起开具，但内分泌学家仅在49%的时间开具。与tTG IgA相比，tTG IgG的开具频率较低（1.9%）。与tTG IgA相比，去酰胺化麦醇溶蛋白肽（DGP）IgA/IgG水平的开具频率也较低（5.4%）。与tTG IgA相比，抗肌内膜抗体的开具较少（0.9%），但CD领域的专业医疗服务提供者开具得较为合适，这与乳糜泻遗传学检查的开具情况（0.8%）类似。在乳糜泻基因检测中，15%的检测开具错误。初级保健提供者开具的tTG IgA阳性率为4.4%。
结论
所有类型的医疗服务提供者开具tTG IgA基本合适。内分泌学家在与筛查实验室一起开具总IgA水平时存在不一致情况。DGP IgA/IgG检测开具不常见，但有一位医疗服务提供者开具不当。抗肌内膜抗体和乳糜泻基因检测的开具数量较少，表明非活检方法的使用不足。与之前的研究相比，初级保健提供者开具的tTG IgA阳性检出率更高。
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