Rostami K, Kerckhaert J, von Blomberg B M, Meijer J W, Wahab P, Mulder C J
Hepatogastroenterology, Rijnstate Hospital, Arnhem, The Netherlands. krostami@hotmailcom
Neth J Med. 1998 Jul;53(1):15-9. doi: 10.1016/s0300-2977(98)00050-3.
The aim of this study was to assess the correlation of sugar absorption test (SAT) using Lactulose/Mannitol/Sucrose (LMS), with IgA-endomysium (EMA), and IgA-gliadin (AGA) antibodies in relation to the severity of the intestinal mucosal damage in adult coeliacs. We have differentiated the Marsh classification in partial villous atrophy (VA) (III a), subtotal VA (III b), and total VA (III c). Twenty-nine untreated adults coeliacs, with a mean age of 47 years, range 20-76 yrs were studied over 3 years. SAT, IgA-AGA and IgA EMA were performed in 29 consecutive coeliac patients with villous atrophy on a gluten containing diets.
Histopathological evaluation of small intestinal mucosa showed a partial VA in 14/29, subtotal VA in 10/29 and total VA in 5/29. All coeliacs with total VA had positive EMA (5/5 100%). However in coeliacs with partial VA sensitivity of EMA was poor (4/14 29%). Sensitivity of EMA in patients with subtotal VA was 50% (5/10). AGA was raised in 3/14 (21%), 6/10 (60%), and in 4/5 (80%) coeliacs with partial, subtotal and total VA respectively. AGA was raised in 13/29 (sensitivity 45%). SAT was abnormal in 26/29 (sensitivity: 89%). One patient had abnormal SAT, EMA and AGA. Eleven of 29 patients (38%) were negative for AGA and EMA, but SAT was abnormal in 10 of them. One patient was positive for EMA, negative for AGA, normal for SAT. EMA and/or AGA were positive in 18/29 (sensitivity 62%). Our study suggests that negative predictive value of serology should be interpreted cautiously since coeliacs with partial VA are negative in serology. Over the last ten years SAT and EMA have been accepted as screening tools for CD. SAT seems to be more sensitive than serology. However there is no standardized agreement in the literature for serology and SAT. A combination of SAT and serology may provide a good sensitivity in order to detect that subgroup of coeliacs with milder histopathological abnormality.
本研究的目的是评估使用乳果糖/甘露醇/蔗糖（LMS）的糖吸收试验（SAT）与成人乳糜泻患者肠黏膜损伤严重程度相关的IgA-内因子（EMA）和IgA-麦醇溶蛋白（AGA）抗体之间的相关性。我们将马什分类法分为部分绒毛萎缩（VA）（III a）、次全VA（III b）和全VA（III c）。对29名未经治疗的成人乳糜泻患者进行了为期3年的研究，他们的平均年龄为47岁，年龄范围在20 - 76岁之间。对29名连续的患有绒毛萎缩且食用含麸质饮食的乳糜泻患者进行了SAT、IgA-AGA和IgA EMA检测。
小肠黏膜的组织病理学评估显示，14/29为部分VA，10/29为次全VA，5/29为全VA。所有全VA的乳糜泻患者EMA均为阳性（5/5，100%）。然而，部分VA的乳糜泻患者中EMA的敏感性较差（4/14，29%）。次全VA患者中EMA的敏感性为50%（5/10）。部分、次全和全VA的乳糜泻患者中AGA升高的比例分别为3/14（21%）、6/10（60%）和4/5（80%）。29名患者中有13名AGA升高（敏感性45%）。29名患者中有26名SAT异常（敏感性：89%）。1名患者SAT、EMA和AGA均异常。29名患者中有11名（38%）AGA和EMA为阴性，但其中10名SAT异常。1名患者EMA阳性，AGA阴性，SAT正常。EMA和/或AGA阳性的有18/29（敏感性62%）。我们的研究表明，由于部分VA的乳糜泻患者血清学呈阴性，血清学的阴性预测值应谨慎解读。在过去十年中，SAT和EMA已被公认为乳糜泻的筛查工具。SAT似乎比血清学更敏感。然而，文献中对于血清学和SAT并没有标准化的共识。SAT和血清学联合使用可能对检测组织病理学异常较轻的乳糜泻亚组具有良好的敏感性。
