Sategna-Guidetti C, Grosso S, Bruno M, Grosso S B
Dipartimento di Fisiopatologia Clinica, Università di Torino, Italy.
J Clin Gastroenterol. 1995 Jan;20(1):17-21. doi: 10.1097/00004836-199501000-00006.
We compared the diagnostic accuracy of a new immunological marker of celiac sprue (CS), the antijejunum antibody (JAB), with that of antigliadin (AGA) and antiendomysium (EmA) antibodies. One hundred untreated adults with biopsy-proven CS, 52 healthy controls, and 57 patients with inflammatory bowel disease, lymphoma of the small bowel, Whipple's disease, and irritable bowel syndrome were investigated. Only JAB and EmA were detected at a similar titer in all patients with untreated CS but in no controls (100% sensitivity and specificity). Sensitivity of AGA was, respectively, 55% for IgA and 78% for Ig class, with a 100 and 82% specificity. The differences in frequencies between both EmA and JAB with IgA and IgG AGA were highly significant. We conclude that JAB and EmA provide a reliable noninvasive screening test for clinically significant gluten-sensitive enteropathy. The lower cost of IgA-JAB is a major advantage, owing to the different availability of the lower third of the esophagus and jejunum from primates. The sensitivity and specificity of the two tests are almost identical, but we find interpreting EmA easier than JAB especially when the titer is low.
我们比较了乳糜泻（CS）的一种新免疫标志物——抗空肠抗体（JAB）与抗麦醇溶蛋白（AGA）和抗肌内膜（EmA）抗体的诊断准确性。研究了100例经活检证实为CS的未经治疗的成年人、52例健康对照者以及57例患有炎症性肠病、小肠淋巴瘤、惠普尔病和肠易激综合征的患者。在所有未经治疗的CS患者中均检测到JAB和EmA，且滴度相似，但在对照者中均未检测到（敏感性和特异性均为100%）。AGA的敏感性，IgA类为55%，Ig类为78%，特异性分别为100%和82%。EmA和JAB与IgA和IgG AGA之间的频率差异非常显著。我们得出结论，JAB和EmA为临床上有意义的麸质敏感性肠病提供了一种可靠的非侵入性筛查试验。由于灵长类动物食管和空肠下三分之一的取材便利性不同，IgA-JAB成本较低是一个主要优势。两种检测方法的敏感性和特异性几乎相同，但我们发现EmA比JAB更容易解读，尤其是滴度较低时。
