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首页> 外文期刊>Clinical Chemistry: Journal of the American Association for Clinical Chemists >Celiac disease and IgA deficiency: complications of serological testing approaches encountered in the clinic.
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Celiac disease and IgA deficiency: complications of serological testing approaches encountered in the clinic.

机译:乳糜泻和IgA缺乏症:临床上遇到的血清学检测方法的并发症。

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BACKGROUND: IgA deficiency causes false-negative IgA-based celiac serology results in patients with celiac disease. Using a case-finding strategy, we examined the prevalence of IgA deficiency, physician evaluation, and management of IgA deficiency during serological testing for celiac disease. METHODS: We reviewed consecutive IgA-endomysial antibody (EMA) and serum IgA results from the laboratory database over 17 months. We cross-referenced seronegative patients with IgA deficiency (IgA <0.06 g/L) to the pathology database to evaluate intestinal biopsy results. Ordering physicians received a questionnaire regarding the management of seronegative patients with IgA deficiency who had no biopsy record. RESULTS: Among the 9533 patients tested for IgA-EMA, 4698 (49%) were tested for IgA deficiency. IgA deficiency occurred in 35 of 4698 (0.75%) patients screened for IgA deficiency. Only 19 of 35 (54%) IgA-deficient patients were diagnosed appropriately with either intestinal biopsy (17 patients) or measurement of IgG-tissue transglutaminase (2 patients). Thirteen (76%) of the 17 IgA-deficient patients who underwent upper endoscopy with or without colonoscopy displayed gastrointestinal pathology on biopsies, including 3 (18%) with celiac disease. No further evaluation to exclude celiac disease was performed for the remaining 16 of 35 (46%) IgA-deficient, EMA-negative patients because of inappropriate management (6 patients), administrative error (7 patients), or patient/physician refusal (3 patients). CONCLUSIONS: IgA deficiency occurred in 1:131 patients tested for celiac disease, and celiac disease occurred in 1:6 of those properly evaluated. Inadequate evaluation of IgA deficiency while testing for celiac disease occurred frequently and resulted in the underdiagnosis of both. Changes in testing algorithms and reporting of results were made to improve testing for celiac disease and IgA deficiency.
机译:背景:IgA缺乏会导致乳糜泻患者基于IgA假阴性的腹腔血清学检查结果。我们使用病例发现策略,在腹腔疾病的血清学检测中检查了IgA缺乏症的患病率,医生评估和IgA缺乏症的管理。方法:我们回顾了实验室数据库中连续17个月的IgA肌内膜抗体(EMA)和血清IgA结果。我们将IgA缺乏症(IgA <0.06 g / L)的血清阴性患者与病理数据库进行交叉参考,以评估肠道活检结果。订购医生收到了一份有关没有活检记录的IgA缺乏血清反应阴性患者的治疗情况的调查表。结果:在9533名接受IgA-EMA检测的患者中,有4698名(49%)接受了IgA缺乏症检测。在筛查IgA缺乏症的4698名患者中,有35例(0.75%)发生了IgA缺乏症。 35名IgA缺陷患者中只有19名(54%)被诊断为进行了肠活检(17名患者)或测量了IgG组织转谷氨酰胺酶(2名患者)。在接受或不接受结肠镜检查的17例IgA缺乏患者中,有13例(76%)在活检组织中表现出胃肠道病理,其中3例(18%)患有腹腔疾病。由于管理不当(6例),管理失误(7例)或患者/医生拒绝(3例),其余35名IgA缺乏,EMA阴性的患者中有16例(46%)未进行排除乳糜泻的进一步评估耐心)。结论:在接受腹腔疾病测试的1:131患者中发生了IgA缺乏症,在经过适当评估的患者中,腹腔疾病的发生率为1:6。在进行乳糜泻测试时,对IgA缺乏症的评估不足,经常导致两者的诊断不足。更改了测试算法并报告了结果,以改善对乳糜泻和IgA缺乏症的测试。

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