Cataldo F, Ventura A, Lazzari R, Balli F, Nassimbeni G, Marino V
Seconda Clinica Pediatrica, Palermo, Italy.
Acta Paediatr. 1995 Oct;84(10):1125-31. doi: 10.1111/j.1651-2227.1995.tb13511.x.
A total of 3783 subjects were enrolled to compare IgA and IgG gliadin antibodies (AGA) with IgA endomysium antibodies (EMA) in coeliac disease (CD). Among 688 children with untreated CD EMA were positive in 93.8%, IgA AGA in 84.9% and IgG AGA in 90.2%. AGA, but not EMA, sensitivity decreased with age. EMA were present in 3.8% of control subjects, IgA AGA in 14.9% and IgG AGA in 34.3%. Follow-up of 5 of 39 EMA-positive controls showed flat mucosa. Combined determination of EMA and AGA showed an increased predictive value: if EMA and AGA were both positive, the mucosa was flat in 99.1%, if both were negative, the mucosa was normal in 99.1%. After a gluten-free diet (GFD), IgA-AGA disappeared first. Among 21 patients not on a strict GFD and in 194 coeliac patients after challenge, EMA, but not AGA, were always positive. Among 67 first-degree relatives of coeliacs, the positive predictive value of EMA was 90.6%, IgA AGA 74.3% and IgG AGA 44.6%. In conclusion, EMA screening is an excellent test for the diagnosis and follow-up of CD, and for identification of its silent and latent forms.
共有3783名受试者参与了一项研究，旨在比较乳糜泻（CD）患者中IgA和IgG麦醇溶蛋白抗体（AGA）与IgA肌内膜抗体（EMA）的情况。在688名未经治疗的CD儿童中，EMA阳性率为93.8%，IgA AGA为84.9%，IgG AGA为90.2%。AGA的敏感性随年龄增长而下降，而EMA并非如此。对照组中，3.8%的受试者EMA呈阳性，14.9%的受试者IgA AGA呈阳性，34.3%的受试者IgG AGA呈阳性。对39名EMA阳性对照组中的5名进行随访，结果显示其黏膜扁平。EMA和AGA联合检测显示预测价值有所提高：如果EMA和AGA均为阳性，则99.1%的患者黏膜扁平；如果两者均为阴性，则99.1%的患者黏膜正常。采用无麸质饮食（GFD）后，IgA-AGA最先消失。在21名未严格遵循GFD的患者以及194名接受激发试验后的乳糜泻患者中，EMA始终呈阳性，而AGA并非如此。在67名乳糜泻患者的一级亲属中，EMA的阳性预测值为90.6%，IgA AGA为74.3%，IgG AGA为44.6%。总之，EMA筛查是诊断和随访CD以及识别其隐匿和潜伏形式的一项出色检测方法。
