BACKGROUND:Tissue transglutaminase (t-TG) is the main autoantigen recognized by the endomysium antibodies (EMA) observed in patients with celiac disease (CD). The aim of the study was to assess an ELISA method for t-TG antibodies (t-TGA) with respect to EMA IF assay in pediatric and adult patients. METHODS:t-TGA were analyzed by ELISA in 220 sera samples: 82 patients with biopsy-proven untreated CD (23 adults and 59 children), 14 CD children on gluten-free diet, 18 asymptomatic relatives of CD patients, and 106 age-matched control patients with gluten-unrelated gastrointestinal diseases (58 adults and 48 children). Serum IgA EMA were tested on umbilical cord sections in all patients. RESULTS:The great majority (92.7%) of untreated CD patients (both adults and children) were t-TGA positive (values ranging from 20.1 to > 300 AU). None of the child control patients and only two out of 58 (3.4%) of the adults with unrelated gastrointestinal diseases had serum t-TGA positivity; two out of 18 first-degree relatives with biopsy-proved silent CD were t-TGA (as well as EMA) positive. Finally, two out of 14 CD children, assuming a gluten-free diet, had serum t-TGA (as well as EMA). A highly significant correlation (P < 0.001) was observed between t-TGA concentrations and EMA. t-TGA showed a sensitivity of 87% and 95%, a specificity of 97% and 100% for adults and children, respectively. CONCLUSION:The method is highly sensitive and specific in the diagnosis of CD and is promising as a tool for routine diagnostic use and population screening, especially in children.

译文

背景:组织转谷氨酰胺酶(t-TG)是在乳糜泻(CD)患者中观察到的被肌内膜抗体(EMA)识别的主要自身抗原。该研究的目的是针对儿童和成人患者的EMA IF分析评估t-TG抗体(t-TGA)的ELISA方法。
方法:通过ELISA对220例血清中的t-TGA进行了分析:82例经活检证实的未经治疗的CD患者(23名成人和59名儿童),14名无麸质饮食的CD儿童,18名无症状CD患者和106例年龄在与患有面筋无关的胃肠疾病的对照患者匹配(58名成人和48名儿童)。对所有患者的脐带切片均进行了血清IgA EMA测试。
结果:未治疗的CD患者(成人和儿童)中绝大多数(92.7%)为t-TGA阳性(值介于20.1至> 300 AU之间)。没有一个儿童对照患者,并且在与胃肠道疾病无关的58位成人中,只有2位(3.4%)的血清t-TGA阳性。经活检证实为无声CD的18名一级亲属中有2名t-TGA(以及EMA)阳性。最后,在接受无麸质饮食的14名CD儿童中,有2名具有血清t-TGA(以及EMA)。在t-TGA浓度和EMA之间观察到高度显着的相关性(P <0.001)。 t-TGA的敏感性分别为87%和95%,对成人和儿童的特异性分别为97%和100%。
结论:该方法对CD的诊断具有高度的敏感性和特异性,有望作为常规诊断应用和人群筛查的工具,尤其是对于儿童。

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