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Non-invasive prediction of persistent villous atrophy in celiac disease

World Journal of Gastroenterology 2020年第26期26卷 3780-3791页

作者： barbora packova Petra Kovalcikova Zdenek Pavlovsky Daniel Bartusek Jitka Prokesova Jiri Dolina Radek Kroupa Department of Gastroenterology and Internal Medicine University Hospital BrnoFaculty of MedicineMasaryk UniversityBrno 62500Czech Republic Institute of Biostatistics and Analyses Faculty of MedicineMasaryk UniversityBrno 62500Czech Republic Department of Pathology University Hospital BrnoFaculty of MedicineMasaryk UniversityBrno 62500Czech Republic Department of Radiology and Nuclear Medicine University Hospital BrnoFaculty of MedicineMasaryk UniversityBrno 62500Czech Republic

BACKGROUND Celiac disease(CD)is an immune-mediated enteropathy that is primarily treated with a gluten-free diet(GFD).Mucosal healing is the main target of the ***,duodenal biopsy is the only way to evaluate mucosal healing,and noninvasive markers are *** elevation of anti-tissue transglutaminase antibodies(aTTG)is not an ideal predictor of persistent villous atrophy(VA).Data regarding prediction of atrophy using anti-deamidated gliadin peptide antibodies(aDGP)and abdominal ultrasonography are *** To evaluate the ability of aTTG,aDGP,small bowel ultrasonography,and clinical and laboratory parameters in predicting persistent VA determined using *** Patients with CD at least 1 year on a GFD and available follow-up duodenal biopsy,levels of aTTG and aDGP,and underwent small bowel ultrasonography were included in this retrospective cohort *** evaluated the sensitivity,specificity,and positive and negative predictive values of aTTG,aDGP,small bowel ultrasonography,laboratory and clinical parameters to predict persistent VA.A receiver operating characteristic(ROC)curve analysis of antibody levels was used to calculate cut off values with the highest accuracy for atrophy *** Complete data were available for 82 patients who were followed up over a period of four years(2014-2018).Among patients included in the analysis,women(67,81.7%)were predominant and the mean age at diagnosis was 33.8 *** biopsy revealed persistent VA in 19 patients(23.2%).The sensitivity and specificity of aTTG using the manufacturer’s diagnostic cutoff value to predict atrophy was 50%and 85.7%,respectively,while the sensitivity and specificity of aDGP(using the diagnostic cutoff value)was 77.8%and 75%,*** of an optimal cutoff value using ROC analysis(13.4 U/mL for aTTG IgA and 22.6 U/mL for aDGP IgA)increased the accuracy and reached 72.2%[95%confidence interval(CI):46.5-90.3]sensitivity and 90%(9

关键词： Celiac disease Villous atrophy Anti-tissue transglutaminase antibodies Antideamidated gliadin peptide antibodies Abdominal ultrasound Gluten-free diet

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