血清特异性抗体在儿童麸质敏感性肠病的研究

Study of serum specific antibodies in children with gluten sensitive enteropathy

目的通过分析麸质敏感性肠病(GSE)患儿血清特异性抗体转谷氨酰胺酶抗体(TGA)、肌内膜抗体(EMA)及脱氨基麦胶蛋白肽抗体(DGP)的检出情况,为临床筛查和诊断GSE提供依据。方法选取2018年1月至2020年10月该院50例GSE患儿作为GSE组,并按照年龄分为≤7岁组和>7岁组。另选取同期健康儿童30例、自身免疫性肝炎5例、过敏性紫癜10例、炎症性肠病5例共50例作为对照组,分别进行TGA、EMA、DGP检测,并对结果进行分析。结果GSE组主要临床表现为慢性腹痛腹泻、贫血、营养不良、生长发育迟缓和焦虑抑郁。GSE组TGA-IgA、TGA-IgG、EMA-IgA、EMA-IgG、DGP-IgA、DGP-IgG阳性率分别为90.0%、66.0%、92.0%、94.0%、92.0%、96.0%,均明显高于对照组(P<0.05)。在对GSE的诊断效能上,DGP-IgG的曲线下面积(AUC)最大(97.0%),而TGA-IgG的AUC最小(81.0%),TGA、EMA、DGP的IgA和IgG特异度均大于94.0%,EMA、DGP的IgA和IgG灵敏度均大于90.0%,但TGA-IgG灵敏度较低(66.0%);多项目联用DGP-IgA+IgG的AUC最高(99.0%)。≤7岁组DGP-IgG和TGA+EMA+DGP诊断效能最好,灵敏度、特异度、阳性预期值、阴性预期值均为100.0%;>7岁组TGA-IgA诊断效能最好,灵敏度、特异度、阳性预期值、阴性预期值均为96.2%。≤7岁组TGA-IgA灵敏度为75.0%,>7岁组TGA-IgA灵敏度为96.2%,两组比较差异有统计学意义(P<0.05);≤7岁组TGA-IgG灵敏度为45.8%,>7岁组TGA-IgG灵敏度为84.6%,两组比较差异有统计学意义(P<0.05)。结论血清特异性抗体DGP-IgG可作为儿童GSE的首选筛查抗体。

Objective To provide a basis for clinical screening and diagnosis of gluten sensitive enteropathy(GSE)by analyzing the detection of serum-specific antibodies transglutaminase antibody(TGA),endomysial antibody(EMA)and deamidated gliadin peptide antibody(DGP)in the children with GSE.Methods A total of 50 children with GSE in the hospital from January 2018 to October 2020 were selected as the GSE group.The children were divided into the≤7-year-old group and>7-year-old group according to their age.Another 30 cases of healthy children,five cases of autoimmune hepatitis,ten cases of allergic purpura and five cases of inflammatory bowel disease in the same period were selected as the control group.The TGA,EMA and DGP tests were performed respectively and the results were analyzed.Results The main clinical manifestations in the GSE group were chronic abdominal pain and diarrhea,anaemia,malnutrition,growth retardation and anxiety and depression.In the GSE group,TGA-IgA,TGA-IgG,EMA-IgA EMA-IgG,DGP-IgA,and DGP-IgG positive rates were 90.0%,66.0%,92.0%,94.0%,92.0%,and 96.0%,respectively,which were significantly higher than those of the control group(P<0.05).In terms of diagnostic efficacy for GSE,DGP-IgG had the highest area under the curve(AUC,97.0%).In contrast,TGA-IgG had the lowest AUC(81.0%).The specificity of IgA and IgG for TGA,EMA and DGP was greater than 94.0%,and the sensitivity of IgA and IgG for EMA and DGP was greater than 90.0%,but that of TGA-IgG was lower(66.0%).The highest AUC(99.0%)was obtained for the multi-item combination DGP-IgA+IgG.The diagnostic efficacy of DGP-IgG and TGA+EMA+DGP was best in the≤7-year-old group,with 100%sensitivity,specificity,positive expected value and negative expected value.TGA-IgA was the most effective in the>7-year-old group,with a sensitivity,specificity,positive expected value and negative expected value of 96.2%.The sensitivity of TGA-IgA was 75.0%in the≤7-year-old group and 96.2%in the>7-year-old group.The difference between the two groups was statistically significant(P<0.05).The sensitivity of TGA-IgG was 45.8%in the≤7-year-old group and 84.6%in the>7-year-old group.There was a statistically significant difference between the two groups(P<0.05).Conclusion The serum-specific antibody DGP-IgG can be used as the screening antibody of choice for GSE in children.