Kaul Sanjeevani, Malik Rohan, Pandey Tapish, Saini Savita, Singh Alka, Das Prasenjit, Makharia Govind
Division of Pediatric Gastroenterology, Department of Pediatrics, All India Institute of Medical Sciences, New Delhi, 110 029, India.
Department of Gastroenterology and Human Nutrition, All India Institute of Medical Sciences, New Delhi, 110 029, India.
Indian J Gastroenterol. 2025 Jul 9. doi: 10.1007/s12664-025-01796-2.
Intestinal fatty acid binding protein (IFABP) is a marker of intestinal epithelial injury and has been studied as a surrogate for predicting villous atrophy. The aim of this study was to evaluate the utility of IFABP in the non-invasive diagnosis of celiac disease (CeD) in children.
Symptomatic children with positive anti-tissue transglutaminase antibody underwent a duodenal biopsy and IFABP measurement. Controls were included who had both tissue transglutaminase antibody (tTG) and IFABP measured. We evaluated the performance of IFABP in the diagnosis of CeD by generating the receiver operating characteristic (ROC) curve.
Total 123 children were screened; 98 had a positive anti-tTG, 74 patients aged 8.5 ± 4.0 years were diagnosed to have CeD and 24 patients had a normal biopsy. Seventy-six children aged 8.4 ± 4.0 years were enrolled as controls. Serum IFABP was significantly higher in children with CeD; median 918 pg/mL (interquartile range [IQR] = 630-1316) as compared to controls; median 386 pg/mL (IQR = 125-581) (p < 0.001). We observed increasing serum IFABP levels with a higher Marsh grade of mucosal injury (p < 0.001). Sensitivity and specificity for diagnosis of CD were 51% and 88% at serum IFABP level > 920 pg/mL and area under the curve (AUC) of 0.79 (0.67-0.90). In children with CD and a tTG 1-10 of normal, this cut-off could make a diagnosis without biopsy in 28/34 cases.
Serum IFABP can improve the non-invasive diagnosis of CeD in children with elevated tTG-IgA titers in a subset of patients and also has good correlation with the degree of villous atrophy.
肠脂肪酸结合蛋白（IFABP）是肠上皮损伤的标志物，已被作为预测绒毛萎缩的替代指标进行研究。本研究的目的是评估IFABP在儿童乳糜泻（CeD）非侵入性诊断中的应用价值。
有症状且抗组织转谷氨酰胺酶抗体阳性的儿童接受十二指肠活检和IFABP检测。纳入同时检测了组织转谷氨酰胺酶抗体（tTG）和IFABP的对照者。我们通过绘制受试者操作特征（ROC）曲线来评估IFABP在CeD诊断中的性能。
共筛查了123名儿童；98名抗tTG阳性，74名年龄为8.5±4.0岁的患者被诊断为CeD，24名患者活检正常。76名年龄为8.4±4.0岁的儿童作为对照。CeD患儿的血清IFABP显著更高；中位数为918 pg/mL（四分位间距[IQR]=630 - 1316），而对照组中位数为386 pg/mL（IQR = 125 - 581）（p<0.001）。我们观察到随着黏膜损伤的马什分级升高，血清IFABP水平升高（p<0.001）。血清IFABP水平>920 pg/mL时，诊断CD的敏感性和特异性分别为51%和88%，曲线下面积（AUC）为0.79（0.67 - 0.90）。在CD且tTG 1 - 10正常的儿童中，该临界值可在28/34例病例中无需活检即可做出诊断。
血清IFABP可改善tTG - IgA滴度升高的部分患儿CeD的非侵入性诊断，并且与绒毛萎缩程度也具有良好相关性。
