Carroccio A, Custro N, Montalto G, Giannitrapani L, Soresi M, Notarbartolo A
Cattedra di Medicina Interna, Università di Palermo, Italia.
Digestion. 1999 Jan-Feb;60(1):86-8. doi: 10.1159/000007595.
Anti-endomysial antibodies (EmA) have been shown to have a high specificity and sensitivity in celiac disease (CD) diagnosis, and their use is considered effective in improving the diagnostic accuracy of CD screening.
To report the clinical details of transient IgA EmA positivity in a patient with Graves' disease.
We screened 48 patients (7 males, age range 19-79, median 58.3 years) for CD. They were hospitalized for thyroid disorders (30 patients had autoimmune hypothyroidism and 18 had Graves' disease with clinical hyperthyroidism associated with diffuse goitre). CD screening was carried out on all patients by assaying serum anti-gliadin antibodies (AGA) and EmA.
None of the 48 patients in our study were positive for IgA and/or IgG-class AGA and none showed IgA deficiency. Only 1 patient was positive for EmA; however, intestinal biopsy in this subject was normal both when thyroiditis was first diagnosed and subsequently after 2 and 3 years. Furthermore, EmA became negative after 2 years. New gastroenterological investigations performed 3 years after the diagnosis confirmed the normal intestinal histology and absorption capacity. Moreover, AGA, EmA and tissue transglutaminase antibodies were negative.
This study underlines the possibility of transient EmA positivity without any signs of CD in patients with autoimmune thyroid disorders.
抗肌内膜抗体（EmA）在乳糜泻（CD）诊断中具有高特异性和敏感性，其应用被认为能有效提高CD筛查的诊断准确性。
报告1例格雷夫斯病患者出现短暂性IgA EmA阳性的临床细节。
我们对48例患者（7例男性，年龄范围19 - 79岁，中位数58.3岁）进行了CD筛查。他们因甲状腺疾病住院（30例患有自身免疫性甲状腺功能减退症，18例患有格雷夫斯病伴临床甲状腺功能亢进症及弥漫性甲状腺肿）。通过检测血清抗麦胶蛋白抗体（AGA）和EmA对所有患者进行CD筛查。
我们研究中的48例患者均未出现IgA和/或IgG类AGA阳性，也未显示IgA缺乏。仅1例患者EmA阳性；然而，该患者在首次诊断甲状腺炎时以及随后2年和3年后的肠道活检均正常。此外，2年后EmA转为阴性。诊断后3年进行的新的胃肠病学检查证实肠道组织学和吸收能力正常。而且，AGA、EmA和组织转谷氨酰胺酶抗体均为阴性。
本研究强调了自身免疫性甲状腺疾病患者可能出现短暂性EmA阳性而无任何CD迹象。
