Lerner A, Kumar V, Iancu T C
Department of Paediatrics, Carmel Hospital, B. Rappaport Faculty of Medicine, Technion-Israel Institute of Technology, Haifa.
Clin Exp Immunol. 1994 Jan;95(1):78-82. doi: 10.1111/j.1365-2249.1994.tb06018.x.
The immunological markers proposed to supplement intestinal biopsy for the diagnosis of coeliac disease are antigliadin, antireticulin and antiendomysial antibodies. These antibodies have been studied separately or compared as pairs, but no prospective comparison of all three antibodies in childhood coeliac disease exists. Thirty-four confirmed coeliacs were compared with nine non-coeliacs with pathological small intestines, and 32 children with a normal intestinal histology. Sera were examined for IgG- and IgA-antigliadin antibodies (AGA) by ELISA, and for IgA-antireticulin antibodies (ARA) and IgA endomysial antibodies (EMA) by indirect immunofluorescence. In active coeliac disease, IgA-EMA was the most sensitive (97%), while IgA-AGA the least sensitive antibody (52%). The specificity of IgA-AGA, IgG-AGA, IgA-ARA, IgA-EMA was 95%, 92%, 100% and 98%, respectively. Positive predicted values of ARA and EMA were comparable (97-100%), while EMA had the highest negative predicted value (98%). Compared with IgG-AGA, IgA-EMA titres better reflected variations in dietary gluten, and correlated best with intestinal pathology. Compared with AGA and ARA sensitivity, specificity and predictive values, EMA is the most reliable serological marker for the diagnosis of coeliac disease. It reflects dietary changes in gluten and correlates best with intestinal histopathology. Therefore, it should be considered the best of the three serological tests available for childhood coeliac disease.
为辅助小肠活检诊断乳糜泻而提出的免疫标志物是抗麦醇溶蛋白、抗网硬蛋白和抗肌内膜抗体。这些抗体已分别进行研究或成对比较，但尚无关于儿童乳糜泻中这三种抗体的前瞻性比较。将34例确诊的乳糜泻患者与9例小肠病理异常的非乳糜泻患者以及32例小肠组织学正常的儿童进行比较。通过酶联免疫吸附测定法检测血清中的IgG和IgA抗麦醇溶蛋白抗体（AGA），通过间接免疫荧光法检测IgA抗网硬蛋白抗体（ARA）和IgA肌内膜抗体（EMA）。在活动性乳糜泻中，IgA-EMA最敏感（97%），而IgA-AGA最不敏感（52%）。IgA-AGA、IgG-AGA、IgA-ARA、IgA-EMA的特异性分别为95%、92%、100%和98%。ARA和EMA的阳性预测值相当（97%-100%），而EMA的阴性预测值最高（98%）。与IgG-AGA相比，IgA-EMA滴度能更好地反映饮食中麸质的变化，且与肠道病理相关性最佳。与AGA和ARA的敏感性、特异性及预测值相比，EMA是诊断乳糜泻最可靠的血清学标志物。它能反映麸质饮食变化，且与肠道组织病理学相关性最佳。因此，它应被视为儿童乳糜泻三种可用血清学检测中最佳的一种。
