Bodé S, Weile B, Krasilnikoff P A, Gudmand-Høyer E
Department of Pediatrics, Gentofte Hospital, University of Copenhagen, Denmark.
J Pediatr Gastroenterol Nutr. 1993 Oct;17(3):260-4. doi: 10.1097/00005176-199310000-00005.
Serum gliadin antibodies (IgA/IgG) were determined in 191 consecutive children (median age, 2.75 years; range, 0.33-15.5 years) admitted for a small-intestinal biopsy on suspicion of celiac disease. The test was a diffusion-in-gel enzyme-linked immunosorbent assay (DIG-ELISA). Of these 191, 14 (7.3%) appeared to have untreated celiac disease. Depending on the choice of cut-off value of the test (combined determination of IgA and IgG), the sensitivity was 86-100%, the specificity was 97-99%, and the positive/negative predictive values were 70-92% and 99-100%, respectively. No variation according to age was found. Gliadin antibodies were determined in 47 children who had well-treated celiac disease. Fourteen of these children were also investigated when challenged with gluten. Gliadin antibodies (IgA or IgG) decreased significantly in 13 of 13 cases when the patients shifted from a gluten-containing diet to a gluten-free one. During the gluten challenge, the IgG and IgA increased in 14 of 14 and 11 of 14 cases, respectively (two patients suffered from IgA deficiency). In eight patients who later appeared to be free of celiac disease, the gliadin antibodies were determined on gluten-free diet and during gluten challenge; no significant differences in gliadin antibodies were found. We conclude that this test is useful in selecting patients with symptoms suggesting celiac disease for a small-intestinal biopsy. The test seems to be of some value in monitoring the effects of a gluten-free diet and during gluten challenge.
对191名因疑似乳糜泻而接受小肠活检的连续儿童（中位年龄2.75岁；范围0.33 - 15.5岁）测定了血清麦醇溶蛋白抗体（IgA/IgG）。检测方法为凝胶扩散酶联免疫吸附测定（DIG - ELISA）。在这191名儿童中，14名（7.3%）似乎患有未经治疗的乳糜泻。根据检测（IgA和IgG联合测定）临界值的选择，敏感性为86 - 100%，特异性为97 - 99%，阳性/阴性预测值分别为70 - 92%和99 - 100%。未发现随年龄的变化。对47名已接受良好治疗的乳糜泻儿童测定了麦醇溶蛋白抗体。其中14名儿童在接受麸质激发试验时也进行了研究。当患者从含麸质饮食转为无麸质饮食时，13例中的13例麦醇溶蛋白抗体（IgA或IgG）显著下降。在麸质激发试验期间，14例中的14例IgG升高，14例中的11例IgA升高（2例患者存在IgA缺乏）。对8名后来似乎无乳糜泻的患者在无麸质饮食时和麸质激发试验期间测定了麦醇溶蛋白抗体；未发现麦醇溶蛋白抗体有显著差异。我们得出结论，该检测对于选择有疑似乳糜泻症状的患者进行小肠活检是有用的。该检测在监测无麸质饮食的效果以及麸质激发试验期间似乎有一定价值。
