Çölyak Hastası Çocuklarda Duodenal Histopatoloji ve Güçlü Pozitif Doku Transglutaminaz Antikorları Arasındaki İlişki

Year 2015, Volume: 13 Issue: 3, 171 - 176, 01.12.2015

Güzide Doğan Semin Ayhan Bilge Yılmaz Yeliz Çağan Appak Pınar Erbay Dündar Talat Ecemiş Fatih Ünal Erhun Kasırga

https://doi.org/10.4274/jcp.81994

Abstract

Giriş: Çölyak hastalığında ÇH güçlü pozitif doku transglutaminaz antikor DTGA düzeylerinin ≥100 U/A hemen daima villöz atrofiye işaret ettiği gösterilmiştir. Bu çalışmanın amacı ≥100 U/A immünoglobulin Ig A tipi DTGA düzeylerinin ÇH tanısındaki yeterliliğini ortaya koymaktır. Gereç ve Yöntem: DTGA pozitifliği nedeniyle endoskopik duodenum biyopsisi yapılan 197 çocuk retrospektif olarak incelendi. IgA DTGA düzeylerinin pozitif değeri >18 U/A idi. Bu eşik değerinin 5 kat veya daha üzerindeki artışlar ≥100 U/A güçlü pozitiflik olarak kabul edildi. ÇH tanısı ESPGHAN ölçütlerine göre konuldu. Modifiye Marsh evre ≥2 ÇH için anlamlı kabul edildi. Bulgular: Olguların 129’u %65,5 kız, 68’i %34,5 erkekti. Duodenum histopatolojisi; olguların 1’inde %0,5 Marsh 0, 17’sinde %8,6 Marsh 2, 41’inde %20,8 Marsh 3a, 81’inde %41,1 Marsh 3b ve 57’sinde %28,9 Marsh 3c ile uyumluydu. Yüz doksan yedi olgunun 64’ünde %32,5 DTGA ≥100 U/ml idi. Güçlü DTGA pozitifliği saptanan olguların duodenum histolojisi 63’ünde Marsh 3 villöz atrofi ve birinde tip 1 diyabetli ve ÇH açısından asemptomatik Marsh 0 normal histoloji ile uyumluydu. DTGA ≥100 U/A olmasının Marsh 3c’nin varlığı için duyarlılığı %85,96 %95 CI: %74,2-%93,7 . Özgüllüğü %89,29 %95 CI: %82,9-%93,8 , pozitif tahmin değeri %76,56 %95 CI: %64,3-%86,2 ve negatif tahmin değeri %93,9 %95 CI: %88,4-%97,3 idi. Sonuç: Bu çalışma güçlü pozitif Ig A DTGA düzeylerinin ≥100 U/A neredeyse her zaman Marsh 3 duodenal histopatolojik değişikliklerle beraber olduğunu göstermiştir. Biyopsi yapılmadan ÇH tanısının konulması ÇH’ye eşlik eden bazı hastalıkların atlanmasına neden olabilir; fakat ileri tetkik edilmiş seçilmiş bazı olgularda çocuk gastroenteroloji uzmanları tarafından endoskopi yapılmadan da ÇH tanısı konulabilir.

Keywords

Çölyak hastalığı, doku transglutaminaz antikoru, duodenum, histopatoloji

Relationship Between Duodenal Histopathology and Strong Positive Tissue Transglutaminase Antibodies in Children with Celiac Disease

Abstract

Introduction: In celiac disease CD strong positive tissue transglutaminase antibody TTGA levels ≥100 U/A have been shown to almost always indicate villous atrophy. The aim of this study is to determine the sufficiency of ≥100 U/A Ig A type TTGA levels for diagnosis of CD. Materials and Methods: Results from duodenum biopsy performed due to positive TTGA in 197 children were retrospectively examined. IgA TTGA levels had a positive value of >18 U/A. Increases of 5 times or more than this threshold value ≥100 U/A are accepted as strong positivity. CD diagnosis was made according to ESPGHAN criteria. A modified Marsh stage ≥2 was accepted as significant for CD. Results: Of the cases, 129 were female 65.5% and 68 were male 34.5% . Duodenum histopathology was compatible with Marsh 0 for 1 case 0.5% , Marsh 2 for 17 cases 8.6% , Marsh 3a for 41 20.8% , Marsh 3b for 81 41.4% and Marsh 3c for 57 28.9% . The TTGA levels of 64 of the 197 cases 32.5% were ≥100 U/A. In cases with strong positivity for TTGA the duodenum histology was compatible with Marsh 3 villous atrophy for 63 and Marsh 0 normal histology for 1 case type 1 diabetic and asymptomatic for CD . For Marsh 3c TTGA levels ≥100 U/A had a sensitivity of 85.96% 95% CI: 74.2-93.7% , specificity of 89.29% 95% CI: 82.9-93.8% , positive predictive value of 76.56% 95% CI: 64.3-86.2% and negative predictive value of 93.9% 95% CI: 88.4- 97.3% . Conclusions: This study showed that positive IgA TTGA levels ≥100 U/A were almost always accompanied by Marsh 3 duodenal histopathological changes. Diagnosis of CD without biopsy may miss certain accompanying diseases, however in some cases with advanced examinations CD may be diagnosed by pediatric gastroenterology specialists without endoscopy.

Keywords

Celiac disease, tissue transglutaminase antibody, duodenum, histopathology

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