测量尿中麸质免疫原性肽在乳糜泻患者临床实践中的作用是什么？

What is the Role of Measuring Urinary Gluten Immunogenic Peptides in Clinical Practice in Patients with Coeliac Disease?

作者信息

Raju Suneil A, Ingham Katerina E, Green Olivia, Johnson Calvin M, Shiha Mohamed G, Nandi Nicoletta, Trott Nick, Penny Hugo A, Hadjivassiliou Marios, Wild Graeme, Sanders David S

机构信息

Academic Unit of Gastroenterology, Sheffield Teaching Hospitals National Health Service Foundation Trust, Sheffield; Division of Clinical Medicine, School of Medicine and Population Health, University of Sheffield, Sheffield, United Kingdom.

Department of Neurology, Royal Hallamshire Hospital, Sheffield Teaching Hospitals National Health Service Foundation Trust, Sheffield, United Kingdom.

出版信息

J Gastrointestin Liver Dis. 2024 Dec 28;33(4):482-487. doi: 10.15403/jgld-5659.

DOI:10.15403/jgld-5659

PMID:39733322

Abstract

BACKGROUND AND AIMS

In coeliac disease, the clinical role of the urinary gluten immunogenic peptide is unclear. It has been suggested it can be a non-invasive marker of villous atrophy. Therefore, we present the largest cross-sectional clinical data in patients with coeliac disease to establish the diagnostic accuracy of the urinary gluten immunogenic peptide in identifying villous atrophy.

METHODS

Patients providing urinary gluten immunogenic peptide were identified between September 2018 and August 2023 at the National Health Service (NHS) England National Centre for Non-Responsive and Refractory CD. In our retrospective study, the results of the urinary gluten immunogenic peptide test collected within 7 days, self-reported adherence to a gluten free diet reported within 3 months, serology collected within 7 days (immunoglobulin A - tissue transglutaminase and endomysial antibody) and histology at the time of endoscopy were compared in individuals with coeliac disease who were either asymptomatic and undergoing remission biopsies (group 1), non-responsive coeliac disease (group 2) and refractory coeliac disease on immunosuppressive therapy (group 3). Associations between dichotomous variables were calculated using chi-squared test.

RESULTS

In group 1 the sensitivity, specificity, positive predictive value (PPV) and negative predictive value (NPV) for detecting villous atrophy were 42.9%, 83.3.%, 64.3% and 67.6% respectively. In group 2 the sensitivity, specificity, PPV and NPV for detecting villous atrophy were 36.2%, 79.0%, 39.5% and 76.6% respectively. In group 3 the sensitivity, specificity, PPV and NPV for detecting villous atrophy were 56.3%, 70.6%, 73.0% and 53.3%. More patients on immunosuppression had a positive urinary gluten immunogenic peptide than those not on immunosuppression (43.3% vs 24.1%, p<0.001).

CONCLUSIONS

The urinary gluten immunogenic peptide does not have a role in identifying villous atrophy. Therefore, to assess for villous atrophy an upper gastrointestinal endoscopy is still required.

摘要

背景与目的

在乳糜泻中，尿中麸质免疫原性肽的临床作用尚不清楚。有人认为它可能是绒毛萎缩的一种非侵入性标志物。因此，我们提供了乳糜泻患者中规模最大的横断面临床数据，以确定尿中麸质免疫原性肽在识别绒毛萎缩方面的诊断准确性。

方法

在2018年9月至2023年8月期间，在英国国家医疗服务体系（NHS）英格兰国家非反应性和难治性乳糜泻中心确定了提供尿中麸质免疫原性肽检测的患者。在我们的回顾性研究中，比较了乳糜泻患者在7天内收集的尿中麸质免疫原性肽检测结果、3个月内自我报告的无麸质饮食依从性、7天内收集的血清学检查结果（免疫球蛋白A - 组织转谷氨酰胺酶和肌内膜抗体）以及内镜检查时的组织学检查结果。这些患者分为无症状且正在接受缓解期活检的患者（第1组）、非反应性乳糜泻患者（第2组）和接受免疫抑制治疗的难治性乳糜泻患者（第3组）。使用卡方检验计算二分变量之间的关联。

结果

在第1组中，检测绒毛萎缩的敏感性、特异性、阳性预测值（PPV）和阴性预测值（NPV）分别为42.9%、83.3%、64.3%和67.6%。在第2组中，检测绒毛萎缩的敏感性、特异性、PPV和NPV分别为36.2%、79.0%、39.5%和76.6%。在第3组中，检测绒毛萎缩的敏感性、特异性、PPV和NPV分别为56.3%、70.6%、73.0%和53.3%。接受免疫抑制治疗的患者尿中麸质免疫原性肽呈阳性的比例高于未接受免疫抑制治疗的患者（43.3%对24.1%，p<0.001）。