Valor de los marcadores serológicos en el diagnóstico de la enfermedad celíaca. Propuesta de un protocolo
Value of serological markers in the diagnosis of celiac disease. a proposed guideline
J.A. Garrote Adrados, E. Arranz Sanz, A. Blanco Quirós
, P.P. Oyaguez Ugidos, C. Calvo Romero, A. Blanco del Val, M. Alonso Franch
Autor para correspondencia
ablanco@ped.uva.es
Correspondencia: Facultad de Medicina. Área de Pediatría. Ramón y Cajal, 5. 47005 Valladolid
Correspondencia: Facultad de Medicina. Área de Pediatría. Ramón y Cajal, 5. 47005 Valladolid
Área de Pediatría. Facultad de Medicina y Hospital Clínico. Universidad de Valladolid
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Alonso Franch" "autores" => array:7 [ 0 => array:2 [ "nombre" => "J.A." "apellidos" => "Garrote Adrados" ] 1 => array:2 [ "nombre" => "E." "apellidos" => "Arranz Sanz" ] 2 => array:4 [ "nombre" => "A." "apellidos" => "Blanco Quirós" "email" => array:1 [ 0 => "ablanco@ped.uva.es" ] "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">*</span>" "identificador" => "cor0005" ] ] ] 3 => array:2 [ "nombre" => "P.P." "apellidos" => "Oyaguez Ugidos" ] 4 => array:2 [ "nombre" => "C." "apellidos" => "Calvo Romero" ] 5 => array:2 [ "nombre" => "A." "apellidos" => "Blanco del Val" ] 6 => array:2 [ "nombre" => "M." "apellidos" => "Alonso Franch" ] ] "afiliaciones" => array:1 [ 0 => array:1 [ "entidad" => "Área de Pediatría. Facultad de Medicina y Hospital Clínico. Universidad de Valladolid" ] ] "correspondencia" => array:1 [ 0 => array:3 [ "identificador" => "cor0005" "etiqueta" => "*" "correspondencia" => "Correspondencia: Facultad de Medicina. Área de Pediatría. Ramón y Cajal, 5. 47005 Valladolid" ] ] ] ] "titulosAlternativos" => array:1 [ "en" => array:1 [ "titulo" => "Value of serological markers in the diagnosis of celiac disease. a proposed guideline" ] ] "pdfFichero" => "main.pdf" "tienePdf" => true "fechaRecibido" => "2000-01-31" "fechaAceptado" => "2000-06-30" "PalabrasClave" => array:2 [ "es" => array:1 [ 0 => array:4 [ "clase" => "keyword" "titulo" => "Palabras clave" "identificador" => "xpalclavsec186524" "palabras" => array:3 [ 0 => "Enfermedad celíaca" 1 => "Anticuerpos antigliadina" 2 => "Anticuerpos antiendomisio IgA" ] ] ] "en" => array:1 [ 0 => array:4 [ "clase" => "keyword" "titulo" => "Keywords" "identificador" => "xpalclavsec186525" "palabras" => array:3 [ 0 => "Celiac disease" 1 => "Antigliadin antibodies" 2 => "Antiendomysial antibodies IgA" ] ] ] ] "tieneResumen" => true "resumen" => array:2 [ "es" => array:1 [ "resumen" => "<span class="elsevierStyleSectionTitle">Objetivo</span><p id="spar0005" class="elsevierStyleSimplePara elsevierViewall">La alta frecuencia de casos atípicos de enfermedad celíaca y de formas con pobre sintomatologia ha potenciado la búsqueda de marcadores analíticos que apoyen la indi-cación de la biopsia intestinal. Las pruebas más extendidas son la determinación de anticuerpos antigliadina de clase IgG e IgA (AAG-IgG y AAG-IgA) y antiendomisio (AEm-IgA).</p> <span class="elsevierStyleSectionTitle">Methods</span><p id="spar0010" class="elsevierStyleSimplePara elsevierViewall">Se presenta la experiencia de 10 años, estudiando AAG en 1.075 sueros de pacientes con enfermedad celíaca y AEm-IgA en 534. Los marcadores séricos se compararon a la biopsia intestinal en 152 casos en los que se realizaron simultáneamente</p> <span class="elsevierStyleSectionTitle">Resultados</span><p id="spar0015" class="elsevierStyleSimplePara elsevierViewall">En los casos con atrofia intestinal grave fue la alta sensibilidad de los AAG-IgG (91 %) y de los AEm-IgA (94%), quienes además mostraron el valor predictivo positivo (88%) y negativo (97%) más altos. Un título positivo de AEm-IgA coincidió con una biopsia alterada al 100 % de los casos. Los AEm-IgA fueron también el marcador más eficaz para el control de la dieta sin gluten. Sin embargo, en los casos con atrofia parcial de la mucosa intestinal ningún marcador fue lo bastante indicativo</p> <span class="elsevierStyleSectionTitle">Conclusiones</span><p id="spar0020" class="elsevierStyleSimplePara elsevierViewall">Los AEm-IgA son el mejor marcador serológico de enfermedad celíaca. A la luz de los resultados y según la prevalencia estimada de esta enfermedad, se proponen protocolos de utilización de los marcadores serológicos para el diagnóstico de los síndromes malabsortivos, para estudios de poblaciones de bajo y alto riesgo de enfermedad celíaca y para el seguimiento de los pacientes diagnosticados.</p>" ] "en" => array:1 [ "resumen" => "<span class="elsevierStyleSectionTitle">Background</span><p id="spar0025" class="elsevierStyleSimplePara elsevierViewall">In recent years, the high frequency of atypical cases of celiac disease (CD) and of forms of this disease with minor symptoms has prompted the search for analytical markers that may support indications for intestinal biopsy. The commonest tests are those for serum class IgG and IgA antigliadin antibodies (IgG-AGA, IgA-AGA) and IgA anti-endomysial antibodies (IgA-EmA).</p> <span class="elsevierStyleSectionTitle">Methods</span><p id="spar0030" class="elsevierStyleSimplePara elsevierViewall">We report our 10-year experience of studying AGA in 1,075 serum samples from patients with CD and IgA-EmA in 534 samples. The serological markers were compared with 152 intestinal biopsies performed simultaneously with the other tests</p> <span class="elsevierStyleSectionTitle">Results</span><p id="spar0035" class="elsevierStyleSimplePara elsevierViewall">In patients with severe intestinal atrophy the sensitivity of IgA-AGA (91 %) and IgA-EmA (94 %) was high. IgA-EmA and the latter showed the highest positive (88 %) and negative (97 %) predictive values. In all patients, IgA-EmA positivity coincided with alterations in the biopsy. Determination of IgA-EmA was also the most efficient marker for monitoring the glutenfree diet phase. However, in patients in whom minimal histological changes were found in the intestinal mucosa, none of the markers was sufficiently accurate.</p> <span class="elsevierStyleSectionTitle">Conclusions</span><p id="spar0040" class="elsevierStyleSimplePara elsevierViewall">IgA-EmA antibodies are the most accurate serological marker of CD. In view of these results and the estimated prevalence of the disease, protocols for the use of serological markers are proposed for the differential diagnosis of malabsorption symptoms, for use in patients at low and high risk of CD and for the follow-up of those with a diagnosis of CD</p>" ] ] "bibliografia" => array:2 [ "titulo" => "Bibliografía" "seccion" => array:1 [ 0 => array:2 [ "identificador" => "bibs0005" "bibliografiaReferencia" => array:38 [ 0 => array:3 [ "identificador" => "bib0005" "etiqueta" => "1." 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| año/Mes | Html | Total | |
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| 2020 Marzo | 40 | 22 | 62 |
| 2020 Febrero | 38 | 32 | 70 |
| 2020 Enero | 38 | 25 | 63 |
| 2019 Diciembre | 57 | 31 | 88 |
| 2019 Noviembre | 46 | 8 | 54 |
| 2019 Octubre | 20 | 28 | 48 |
| 2019 Septiembre | 27 | 29 | 56 |
| 2019 Agosto | 33 | 22 | 55 |
| 2019 Julio | 35 | 38 | 73 |
| 2019 Junio | 32 | 41 | 73 |
| 2019 Mayo | 71 | 59 | 130 |
| 2019 Abril | 40 | 96 | 136 |
| 2019 Marzo | 27 | 55 | 82 |
| 2019 Febrero | 22 | 43 | 65 |
| 2019 Enero | 23 | 39 | 62 |
| 2018 Diciembre | 26 | 34 | 60 |
| 2018 Noviembre | 26 | 33 | 59 |
| 2018 Octubre | 40 | 21 | 61 |
| 2018 Septiembre | 12 | 14 | 26 |
| 2018 Julio | 2 | 0 | 2 |
| 2018 Junio | 1 | 0 | 1 |
| 2018 Mayo | 5 | 0 | 5 |
| 2018 Abril | 11 | 0 | 11 |
| 2018 Marzo | 11 | 0 | 11 |
| 2018 Febrero | 4 | 0 | 4 |
| 2018 Enero | 10 | 0 | 10 |
| 2017 Diciembre | 11 | 0 | 11 |
| 2017 Noviembre | 13 | 0 | 13 |
| 2017 Octubre | 16 | 0 | 16 |
| 2017 Septiembre | 11 | 0 | 11 |
| 2017 Agosto | 10 | 0 | 10 |
| 2017 Julio | 16 | 0 | 16 |
| 2017 Junio | 19 | 21 | 40 |
| 2017 Mayo | 16 | 19 | 35 |
| 2017 Abril | 15 | 19 | 34 |
| 2017 Marzo | 18 | 3 | 21 |
| 2017 Febrero | 13 | 8 | 21 |
| 2017 Enero | 10 | 4 | 14 |
| 2016 Diciembre | 19 | 18 | 37 |
| 2016 Noviembre | 55 | 10 | 65 |
| 2016 Octubre | 41 | 8 | 49 |
| 2016 Septiembre | 38 | 9 | 47 |
| 2016 Agosto | 31 | 7 | 38 |
| 2016 Julio | 23 | 13 | 36 |
| 2016 Junio | 1 | 0 | 1 |
| 2016 Mayo | 1 | 0 | 1 |
| 2016 Marzo | 2 | 0 | 2 |
| 2015 Diciembre | 2 | 0 | 2 |
| 2015 Noviembre | 1 | 0 | 1 |
| 2015 Julio | 13 | 0 | 13 |
| 2015 Junio | 13 | 0 | 13 |
| 2015 Mayo | 17 | 9 | 26 |
| 2015 Abril | 11 | 0 | 11 |
| 2015 Marzo | 18 | 0 | 18 |
| 2015 Febrero | 12 | 0 | 12 |
| 2015 Enero | 19 | 0 | 19 |
| 2014 Diciembre | 17 | 1 | 18 |
| 2014 Noviembre | 12 | 0 | 12 |
| 2014 Octubre | 13 | 0 | 13 |
| 2014 Septiembre | 10 | 0 | 10 |
| 2014 Agosto | 15 | 1 | 16 |
| 2014 Julio | 13 | 1 | 14 |
| 2014 Junio | 15 | 1 | 16 |
| 2014 Mayo | 16 | 1 | 17 |
| 2014 Abril | 13 | 2 | 15 |
| 2014 Marzo | 13 | 4 | 17 |
| 2014 Febrero | 8 | 6 | 14 |
| 2014 Enero | 17 | 10 | 27 |
| 2013 Diciembre | 30 | 7 | 37 |
| 2013 Noviembre | 29 | 4 | 33 |
| 2013 Octubre | 23 | 8 | 31 |
| 2013 Septiembre | 20 | 9 | 29 |
| 2013 Agosto | 14 | 7 | 21 |
| 2013 Julio | 5 | 5 | 10 |
| 2013 Junio | 6 | 1 | 7 |
| 2013 Mayo | 8 | 2 | 10 |
| 2013 Abril | 9 | 2 | 11 |
| 2013 Marzo | 10 | 2 | 12 |
| 2013 Febrero | 26 | 1 | 27 |
| 2013 Enero | 40 | 2 | 42 |
| 2012 Diciembre | 30 | 5 | 35 |
| 2012 Noviembre | 16 | 2 | 18 |
| 2012 Octubre | 6 | 2 | 8 |
| 2012 Septiembre | 11 | 1 | 12 |
| 2012 Agosto | 1 | 0 | 1 |
| 2000 Diciembre | 1388 | 0 | 1388 |
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