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目的对消化道疾病住院儿童中的抗组织谷氨酰胺转移酶(tTG)抗体阳性病例进行分析,探索适合我国儿童乳糜泻疾病诊疗的血清学检测。方法采用ELISA方法检测患儿血清中tTG抗体IgA和IgG,采用间接免疫荧光法检测患儿血清中的抗肌内膜抗体(EMA)和麦胶蛋白抗体(AGA)IgA和IgG。收集所有患儿临床资料,包括小肠黏膜病理分析等。结果 162例患儿中,11例血清IgA-tTG和IgG-AGA阳性。11例中,2例tTG、EMA和AGA全部阳性,3例伴有IgA/IgG-EMA和IgA-AGA阳性,1例伴有IgG-EMA可疑阳性、IgA-EMA和IgAAGA阳性,4伴有IgA-EMA和IgA-AGA阳性,1例伴有IgG-tTG可疑阳性。以上11例IgA-tTG和IgG-AGA阳性患儿十二指肠黏膜都有中重度以上程度损害,8例并发心肌损害、肝功能损害、营养不良、生长发育迟缓等。其中7例临床诊断为乳糜泻、且无麸质饮食试验治疗有效。结论 11例IgA-tTG阳性患儿3种血清抗体检测结果与十二指肠黏膜病理活检相符。血清抗体,特别是tTG检测可以更快更早地帮助临床诊断乳糜泻。
Objective To analyze the positive cases of anti-tissue transglutaminase (tTG) antibody in hospitalized children with gastrointestinal diseases and to explore the serological tests suitable for the diagnosis and treatment of children with celiac disease in our country. Methods Serum tTG antibody IgA and IgG in children were detected by ELISA. The serum anti-endomialin antibody (EMA) and gliadin antibody (AGA) IgA and IgG were detected by indirect immunofluorescence. Collect all the clinical data of children, including pathological analysis of intestinal mucosa. Results Of the 162 children, 11 were positive for serum IgA-tTG and IgG-AGA. Of the 11 cases, 2 were positive for tTG, EMA and AGA, 3 were associated with IgA / IgG-EMA and IgA-AGA, 1 were associated with IgG-EMA positive, IgA-EMA and IgAAGA were positive, and 4 were IgA -EMA and IgA-AGA positive, 1 case with IgG-tTG suspicious positive. The above 11 cases of IgA-tTG and IgG-AGA-positive children with duodenal mucosa have more than moderate and severe damage, 8 cases of myocardial damage, liver damage, malnutrition, growth retardation and so on. Of these, 7 were clinically diagnosed as celiac disease and the gluten-free diet trial was effective. Conclusions The results of three kinds of serum antibodies in 11 cases of IgA-tTG positive children are consistent with pathological biopsy of duodenal mucosa. Serum antibodies, especially the tTG test, can help diagnose celiac disease faster and earlier.