腹部症状の患者におけるセリアック疾患の診断検査:体系的なレビュー
Daniëlle A W M van der Windt1, Petra Jellema, Chris J Mulder
1Arthritis Research UK National Primary Care Centre, Primary Care Sciences, Keele University, Keele, Staffordshire ST5 5BG, UK. d.van.der.windt@cphc.keele.ac.uk
JAMA
|May 6, 2010
まとめ
腹部症状を持つ成人のセリアック病の正確な診断は,非常に敏感で特定の抗体検査に依存しています. IgA抗組織トランスグルタミナーゼとIgA抗エンドミジア抗体は,プライマリケア施設での使用が推奨されています.
科学分野:
- 胃腸内科 胃腸内科
- 免疫学 免疫学とは
- 診断の精度 診断の精度
背景:
- セリアック病の診断と管理には,しばしばグルテンフリーダイエットが含まれますが,症状の呈現は異なります.
- 症状が変化しているため,不必要なセリアック病の診断検査は,初等医療において最小限に抑えるべきである.
研究 の 目的:
- 初等医療における腹部症状のある成人におけるセリアック病の診断のための様々な検査の診断性能を評価する.
- 選択されていない集団におけるセリアック病の診断検査の正確性に関する証拠を要約する.
主な方法:
- MEDLINEとEMBASEのデータベースの体系的な文献レビュー,手動参照検索で補完された.
- コホートまたは内蔵症例対照の設計による診断研究の含有,非急性腹部症状と低乳房病の有病率 (≤15%) を有する成人に焦点を当てた.
- 独立した品質評価とデータ抽出,双変量分析を用いて計算された集合感度と特異度.
主要な成果:
- 16件の研究 (N=6085) をレビューしたところ,腹部症状のパフォーマンスは大きく変化した.
- IgA抗エンドミジア抗体に対するプールの感度および特異性は,それぞれ0.90および0.99でした.
- IgA抗組織型トランスグルタミンゼ抗体に対するプールの感度および特異性は,それぞれ0.89および0.98であった;IgA/IgG抗グリアジン抗体は,変動する結果を示した.
結論:
- IgA抗組織トランスグルタミンゼ抗体とIgA抗エンドミシアル抗体は,腹部症状のある成人のセリアック疾患の診断に高い感度と特異性を示しています.
- これらの抗体検査は,プライマリケアおよび未選択の集団におけるセリアック病の正確な診断のための貴重なツールです.
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