Norwegian Coeliac Disease Research Centre, Institute of Clinical Medicine, University of Oslo, Oslo, Norway.
Department of Immunology, Oslo University Hosptial - Rikshospitalet, Oslo, Norway.
Gut. 2024 Apr 5;73(5):844-853. doi: 10.1136/gutjnl-2023-331595.
Serum antibodies to the autoantigen transglutaminase 2 (TG2) are increasingly harnessed to diagnose coeliac disease. Diagnostic guidelines for children give recommendation for a no-biopsy-based diagnosis through detection of high amounts of IgA anti-TG2 antibodies in serum with confirmation of positivity in a separate blood sample by characteristic autoantibody-staining of tissue. While measurement of IgA anti-TG2 also is important in the diagnostic workup of adults, the adult guidelines still mandate examination of gut biopsies. This requirement might well change in the future, as might the necessity for confirming autoantibody positivity by tissue staining. The key role of autoantibody serology for diagnosis of coeliac disease is paradoxical. Coeliac disease was considered, and still can be considered, a food intolerance disorder where autoantibodies at face value are out of place. The immunological mechanisms underlying the formation of autoantibodies in response to gluten exposure have been dissected. This review presents the current insights demonstrating that the autoantibodies in coeliac disease are intimately integrated in the maladapted immune response to gluten.
血清中针对自身抗原转谷氨酰胺酶 2（TG2）的抗体越来越多地被用于诊断乳糜泻。儿童的诊断指南建议通过检测血清中大量 IgA 抗 TG2 抗体，在另一份血样中通过组织自身抗体染色确认阳性，从而实现无需进行活检的诊断。虽然 IgA 抗 TG2 的测量在成人的诊断中也很重要，但成人指南仍要求检查肠道活检。这种需求在未来很可能会改变，组织染色确认自身抗体阳性的必要性也可能会改变。自身抗体血清学在乳糜泻诊断中的关键作用存在矛盾。乳糜泻曾被认为（现在仍然可以被认为）是一种食物不耐受疾病，而从表面上看，自身抗体是不合适的。导致针对麸质暴露形成自身抗体的免疫机制已经被剖析。这篇综述介绍了目前的研究进展，表明乳糜泻中的自身抗体与对麸质的适应性免疫反应密切相关。
