Korponay-Szabó I R, Kovács J B, Czinner A, Gorácz G, Vámos A, Szabó T
Department of Gastroenterology-Nephrology, Heim Pál Children's Hospital, Budapest, Hungary.
J Pediatr Gastroenterol Nutr. 1999 Jan;28(1):26-30. doi: 10.1097/00005176-199901000-00008.
Because of the different sensitivity and specificity of serologic tests, the search for silent celiac disease is usually performed with the combined or sequential use of several tests. Among these, the IgA-class endomysium antibody test has the highest specificity and positive predictive value, but it may overlook IgA-deficient patients.
To test a new one-step screening approach, serum samples from 427 apparently healthy, 3- to 6-year-old Hungarian children were investigated for IgA-class and IgG-class endomysium antibodies using monkey esophagus and human jejunum as substrates.
Five new cases with flat mucosa were identified by strong endomysium antibody positivity and subsequent jejunal biopsy, yielding a celiac disease prevalence of 1:85. An additional child may have latent celiac disease (slight histologic changes at present). Two of the screening-detected celiac patients exhibited only IgG-class endomysium antibodies due to associated IgA-deficiency. Despite the young age of the screened population, antigliadin antibodies were positive in only three of the five celiac patients.
Prevalence of celiac disease in the study population was much higher than expected on the basis of antigliadin antibody-based studies. The screening system used detected celiac cases in which there was IgA-deficiency and those in which there was not and also those negative for antigliadin antibodies. The findings suggest the importance of the primary testing of autoantibodies in future celiac disease screening policies.
由于血清学检测的敏感性和特异性不同，通常联合使用或序贯使用多种检测方法来筛查无症状性乳糜泻。其中，IgA类肌内膜抗体检测具有最高的特异性和阳性预测值，但可能会遗漏IgA缺乏的患者。
为了测试一种新的一步筛查方法，以猴食管和人空肠为底物，对427名3至6岁看似健康的匈牙利儿童的血清样本进行了IgA类和IgG类肌内膜抗体检测。
通过强肌内膜抗体阳性及随后的空肠活检，确定了5例新的扁平黏膜病例，乳糜泻患病率为1:85。另有一名儿童可能患有潜在乳糜泻（目前有轻微组织学改变）。筛查发现的两名乳糜泻患者因伴有IgA缺乏，仅表现出IgG类肌内膜抗体。尽管筛查人群年龄较小，但5例乳糜泻患者中只有3例抗麦胶蛋白抗体呈阳性。
研究人群中乳糜泻的患病率远高于基于抗麦胶蛋白抗体研究的预期。所使用的筛查系统检测出了存在IgA缺乏和不存在IgA缺乏以及抗麦胶蛋白抗体阴性的乳糜泻病例。这些发现表明自身抗体初筛在未来乳糜泻筛查策略中的重要性。
