Tissue Transglutaminase Antibody and Its Association with Duodenal Biopsy in Diagnosis of Pediatric Celiac Disease
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Purpose: This study aimed to evaluate a possible association between the anti-tissue transglutaminase antibody (anti-tTG) titer and stage of duodenal mucosal damage and assess a possible cut-off value of anti-tTG at which celiac disease (CD) may be diagnosed in children in conjunction with clinical judgment. Methods: This observational study was conducted at a gastroenterology clinic in a tertiary hospital from April 2012 to May 2013. Seventy children between 6-months and 18-years-old with suspected CD underwent celiac serology and duodenal biopsy. Statistical analyses were done using SPSS 16. Diagnostic test values were determined for comparing the anti-tTG titer with duodenal biopsy. An analysis of variance and Tukey-Kramer tests were performed for comparing the means between groups. A receiver operating characteristics curve was plotted to determine various cut-off values of anti-tTG. Results: The mean antibody titer increased with severity of Marsh staging ( p <0.001). An immunoglobulin (Ig) A-tTG value at 115 AU/mL had 76% sensitivity and 100% specificity with a 100% positive predictive value (PPV) and 17% negative predictive value (NPV) for diagnosis of CD ( p <0.001, 95% confidence interval [CI], 0.75–1). Conclusion: There is an association between the anti-tTG titer and stage of duodenal mucosal injury in children with CD. An anti-tTG value of 115 AU/mL (6.4 times the upper normal limit) had 76% sensitivity, 100% specificity, with a 100% PPV, and 17% NPV for diagnosing CD (95% CI, 0.75–1). This cut-off may be used in combination with clinical judgment to diagnose CD.
Abstract
Purpose: This study aimed to evaluate a possible association between the anti-tissue transglutaminase antibody (anti-tTG) titer and stage of duodenal mucosal damage and assess a possible cut-off value of anti-tTG at which celiac disease (CD) may be diagnosed in children in conjunction with clinical judgment. Methods: This observational study was conducted at a gastroenterology clinic in a tertiary hospital from April 2012 to May 2013. Seventy children between 6-months and 18-years-old with suspected CD underwent celiac serology and duodenal biopsy. Statistical analyses were done using SPSS 16. Diagnostic test values were determined for comparing the anti-tTG titer with duodenal biopsy. An analysis of variance and Tukey-Kramer tests were performed for comparing the means between groups. A receiver operating characteristics curve was plotted to determine various cut-off values of anti-tTG. Results: The mean antibody titer increased with severity of Marsh staging ( p <0.001). An immunoglobulin (Ig) A-tTG value at 115 AU/mL had 76% sensitivity and 100% specificity with a 100% positive predictive value (PPV) and 17% negative predictive value (NPV) for diagnosis of CD ( p <0.001, 95% confidence interval [CI], 0.75–1). Conclusion: There is an association between the anti-tTG titer and stage of duodenal mucosal injury in children with CD. An anti-tTG value of 115 AU/mL (6.4 times the upper normal limit) had 76% sensitivity, 100% specificity, with a 100% PPV, and 17% NPV for diagnosing CD (95% CI, 0.75–1). This cut-off may be used in combination with clinical judgment to diagnose CD.
참고문헌 (12)
- Donaldson MR, "Strongly positive tissue transglutaminase antibodies are associated with Marsh 3 histopathology in adult and pediatric celiac disease", J Clin Gastroenterol, 42, pp.256~260 (2008)
- Kalhan S, "Comparative study of histopathological Marsh grading with clinical and serological parameters in celiac iceberg of north India", Indian J Pathol Microbiol, 54, pp.279~283 (2011)
- Parizade M, "Performance of serology assays for diagnosing celiac disease in a clinical setting", Clin Vaccine Immunol, 16, pp.1576~1582 (2009)
- Barker CC, "Can tissue transglutaminase antibody titers replace small-bowel biopsy to diagnose celiac disease in select pediatric populations?", Pediatrics, 115, pp.1341~1346 (2005)
- Sugai E, "Accuracy of testing for antibodies to synthetic gliadin-related peptides in celiac disease", Clin Gastroenterol Hepatol, 4, pp.1112~1117 (2006)
- Vivas S, "Duodenal biopsy may be avoided when high transglutaminase antibody titers are present", World J Gastroenterol, 15, pp.4775~4780 (2009)
- Oberhuber G, "The histopathology of coeliac disease : time for a standardized report scheme for pathologists", Eur J Gastroenterol Hepatol, 11, pp.1185~1194 (1999)
- Zanini B, "High tissue-transglutaminase antibody level predicts small intestinal villous atrophy in adult patients at high risk of celiac disease", Dig Liver Dis, 44, pp.280~285 (2012)
- Alessio MG, "Correlation between IgA tissue transglutaminase antibody ratio and histological finding in celiac disease", J Pediatr Gastroenterol Nutr, 55, pp.44~49 (2012)
- Rahmati A, "Correlation of tissue transglutaminase antibody with duodenal histologic marsh grading", Middle East J Dig Dis, 6, pp.131~136 (2014)
- Paul SP, "Barriers to implementing the revised ESPGHAN guidelines for coeliac disease in children : a cross-sectional survey of coeliac screen reporting in laboratories in England", Arch Dis Child, 102, pp.942~946 (2017)
- Husby S, "European Society for Pediatric Gastroenterology, Hepatology, and Nutrition guidelines for the diagnosis of coeliac disease", J Pediatr Gastroenterol Nutr, 54, pp.136~160 (2012)