Lorini R, Scotta M S, Cortona L, Avanzini M A, Vitali L, De Giacomo C, Scaramuzza A, Severi F
Department of Paediatrics, University of Pavia, Policlinico San Matteo I.R.C.C.S., Italy.
J Diabetes Complications. 1996 May-Jun;10(3):154-9. doi: 10.1016/1056-8727(96)00056-6.
To ascertain the specificity of IgA and IgG antigliadin (IgA-AGA, IgG-AGA), IgA-antireticulin (R1-ARA), and antiendomysial (AEA) antibodies for the diagnosis of celiac disease, we evaluated 133 type I diabetic children aged 1.4-28.4 years (mean 14.1 +/- 6.6), with diabetes from onset to 20.5 years. Fifty-three patients were considered at onset and 49 of these also during follow-up. IgA-AGA and IgG-AGA were determined by enzyme-linked immunosorbent assay (ELISA), R1-ARA and AEA by indirect immunofluorescence. IgA-AGA were positive in 20 of 133 (15%), IgG-AGA were positive in seven of 133 (5.26%), while R1-ARA and AEA were positive in three patients. At the onset of disease we found elevated IgA-AGA in 17 of 53 (32%) patients, IgG-AGA in four (7.55%) patients, three of them with IgA-AGA as well; R1-ARA and AEA were present in three (5.66%) patients, all with high IgA-AGA levels. During 1-10 year follow-up IgA-AGA decreased to within the normal range in 13 patients, with elevated IgA-AGA at onset but without R1-ARA and AEA; in four patients with high IgA-AGA at onset, IgA-AGA remained constantly elevated as did R1-ARA and AEA in three of them; and two patients, without IgA-AGA, R1-ARA, and AEA at onset, became positive for all three antibodies. Intestinal biopsy confirmed a diagnosis of celiac disease in five of these with IgA-AGA, R1-ARA, and AEA, but not in one patient with persistent IgA-AGA but no AEA and R1-ARA, suggesting that R1-ARA and AEA are more reliable markers for the screening of celiac disease in type I diabetic patients.
为确定IgA和IgG抗麦醇溶蛋白抗体（IgA-AGA、IgG-AGA）、IgA抗网硬蛋白抗体（R1-ARA）及抗肌内膜抗体（AEA）对乳糜泻诊断的特异性，我们评估了133例1.4至28.4岁（平均14.1±6.6岁）的I型糖尿病儿童，其糖尿病病程从发病至20.5年。53例患者在发病时接受评估，其中49例在随访期间也接受了评估。IgA-AGA和IgG-AGA通过酶联免疫吸附测定（ELISA）检测，R1-ARA和AEA通过间接免疫荧光检测。133例中有20例（15%）IgA-AGA呈阳性，133例中有7例（5.26%）IgG-AGA呈阳性，而3例患者R1-ARA和AEA呈阳性。在疾病发病时，我们发现53例患者中有17例（32%）IgA-AGA升高，4例（7.55%）患者IgG-AGA升高，其中3例同时伴有IgA-AGA升高；3例（5.66%）患者存在R1-ARA和AEA，均伴有高IgA-AGA水平。在1至10年的随访中，13例发病时IgA-AGA升高但无R1-ARA和AEA的患者，其IgA-AGA降至正常范围；4例发病时IgA-AGA高的患者中，3例患者的IgA-AGA持续升高，R1-ARA和AEA也持续升高；2例发病时无IgA-AGA、R1-ARA和AEA的患者，这三种抗体均转为阳性。肠道活检证实，5例伴有IgA-AGA、R1-ARA和AEA的患者患有乳糜泻，但1例持续存在IgA-AGA但无AEA和R1-ARA的患者未患乳糜泻，这表明R1-ARA和AEA是I型糖尿病患者筛查乳糜泻更可靠的标志物。
