Gastroenterology, Department of Clinical Medicine and Surgery, Federico II University Hospital, Naples, Italy.
Gastroenterology, Department of Clinical Medicine and Surgery, Federico II University Hospital, Naples, Italy.
Dig Liver Dis. 2024 Jun;56(6):988-993. doi: 10.1016/j.dld.2024.03.002. Epub 2024 Mar 26.
Anti-endomysial antibodies (EMA) and anti-tissue transglutaminases (a-tTg) play a pivotal role in coeliac disease (CD) diagnosis. Deamidated anti-gliadin peptides (DGP) were added to the CD diagnostic workup.
We aimed to compare the diagnostic accuracies of ELISA-based (a-tTg/DGP) and immunofluorescence-ELISA-based strategies (EMA/a-tTg) for CD diagnosis.
From November 2020 to November 2022, we undertook an observational prospective study including consecutive adult patients with suspected CD. All subjects were tested for EMA, a-tTg and DGP IgA. An ROC curve was plotted to establish the best specificity cut-off of a-tTg and DGP levels, which would predict the presence of Marsh≥2 and Marsh=3. The diagnostic accuracies of a-tTg/DG and EMA/a-tTg were compared.
The study included 275 CD patients. Histology showed Marsh=1 in 9.9%, Marsh=2 in 4.5%, and Marsh=3 in 85.6.%. The best cut-off value of a-tTg for predicting Marsh≥2 was 42 U/mL, while the best cut-off for predicting atrophy was 68.4 U/mL. The best cut-off value of DGP for predicting Marsh≥2 was 56 U/mL, while the best cut-off for predicting atrophy was 78 U/mL. A-tTg/EMA showed 97% sensitivity and 100% specificity, whereas a-tTg/DGP showed 94% sensitivity and 100% specificity.
A-tTg/DGP is accurate for CD diagnosis and could reduce costs and operator-dependency of EMA. DGP, together with a-tTg, could replace EMA in CD diagnosis.
抗内膜抗体（EMA）和抗组织转谷氨酰胺酶（a-tTg）在乳糜泻（CD）诊断中起着关键作用。脱酰胺麦胶蛋白肽（DGP）已被添加到 CD 的诊断中。
我们旨在比较基于 ELISA（a-tTg/DGP）和基于免疫荧光 ELISA（EMA/a-tTg）的策略对 CD 诊断的诊断准确性。
从 2020 年 11 月至 2022 年 11 月，我们进行了一项观察性前瞻性研究，纳入了连续的疑似 CD 的成年患者。所有患者均进行 EMA、a-tTg 和 DGP IgA 检测。绘制 ROC 曲线以确定 a-tTg 和 DGP 水平的最佳特异性截断值，该截断值可预测 Marsh≥2 和 Marsh=3 的存在。比较 a-tTg/DG 和 EMA/a-tTg 的诊断准确性。
该研究纳入了 275 例 CD 患者。组织学显示 Marsh=1 占 9.9%，Marsh=2 占 4.5%，Marsh=3 占 85.6%。预测 Marsh≥2 的 a-tTg 最佳截断值为 42 U/mL，而预测萎缩的最佳截断值为 68.4 U/mL。预测 Marsh≥2 的 DGP 最佳截断值为 56 U/mL，而预测萎缩的最佳截断值为 78 U/mL。a-tTg/EMA 具有 97%的敏感性和 100%的特异性，而 a-tTg/DGP 具有 94%的敏感性和 100%的特异性。
a-tTg/DGP 对 CD 诊断准确，可以降低 EMA 的成本和对操作人员的依赖性。DGP 与 a-tTg 一起可替代 CD 诊断中的 EMA。
