除了活检之外:评估非侵入性技术来诊断成年人患乳病的疾病
Suzanne Cauchi1, Abigail Pace1, Martina Sciberras1
1Department of Medicine, Division of Gastroenterology and Hepatology, Mater Dei Hospital, Msida, Malta (Suzanne Cauchi, Abigail Pace, Martina Sciberras, Pierre Ellul).
Annals of gastroenterology
|May 15, 2025
概括
较高的免疫球蛋白A抗组织转质胺酶 (IgA tTg) 抗体水平 (≥10 × ULN) 与腹腔疾病 (CD) 诊断有很强的相关性. 这一发现支持在成年人中诊断CD的无活检方法.
科学领域:
- 胃肠病学 胃肠病学
- 免疫学 免疫学 免疫学
- 临床诊断 临床诊断 临床诊断
背景情况:
- 十二指肠活检是乳病 (CD) 诊断的标准.
- 对CD的无活检诊断方法正在获得引力.
- 较高的免疫球蛋白A抗组织转质胺酶 (IgA tTg) 抗体水平可能会避免对组织学的需要.
研究的目的:
- 评估IgA tTg抗体标位≥10倍高于正常的上限 (ULN) 和成年人的组织学CD诊断之间的相关性.
- 评估基于IgA tTg水平的CD诊断的无活检方法的有用性.
主要方法:
- 对经过上部胃肠道内镜与十二指肠活检 (2012-2024) 的成年患者的回顾性分析.
- 收集有关人口统计,症状,风险因素,血清学 (IgA tTg,EMA) 和组织学的数据.
- 对血清检测呈阳性和最初呈阴性活检的患者进行审查.
主要成果:
- 在114名患者中,70.2%的人在组织学上证实了乳性疾病.
- 在97.4%的患者中,IgA tTg抗体呈阳性,而在93.8%的患者中,内抗体 (EMA) 呈阳性.
- IgA tTg水平≥10 × ULN (发现在41.2%) 显示了100%的特异性和100%的CD阳性预测值,敏感度为58.8%.
结论:
- 高IgA tTg水平 (≥10 × ULN) 与组织学CD诊断有很强的相关性.
- 当IgA tTg水平≥10 × ULN时,特别是EMA阳性和典型症状时,支持用于CD诊断的无活检方法.
- 这种方法可能会减少对侵入性内镜手术的需要.
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