Význam stanovení antigliadinových a antiendomyziálních protiláteka HLA-DR, DQ genotypu u malých dětí s atrofií jejunální sliznice

Importance of Assessment of Antigliadin and Antiendomysial Antibodies and HLA-DR, DQGenotype in Young Children with Small Bowel Mucosal Atrophy

The objective of investigation was to assess whether contemporary assessment of antigliadin antibodies (AGA),antiendomysial antibodies (EMA) and HLA-DR, DQ haplotypes in children under two year s at the time of the firstbiopsy of small bowel which provided evidence of small bowel mucosal atrophy will contribute to differentiationof the etiology of mucosal atrophy. In the submitted study the authors used data from a group of 24 children whoat the time of the first biopsy of small bowel (EB) were younger than two years and EB provided evidence of smallbowel mucosal atrophy. After the second EB made after the gluten challenge the definite diagnosis in 18 childrenwas celiac disease (CD) and in 6 children CD was ruled out. EMA antibodies were positive in 17 of 18 childrenwith CD (in one instance IgA deficiency was involved) and negative in all six children with non-coeliac atrophy ofthe small bowel (non-CD). AGA-IgA were positive in 15 of 18 children with CD and in none with n on-CD. AGA-IgGwere positive in all children with CD and in one with non-CD. All children with CD had HLA haplotypes typicalfor CD, but also 3 of 6 children with non-CD had haplotypes typical for CD. A single examination of EMA, AGA,HLA alleles class II of loci DRB1, DQA1, DQB1 and bioptical examination renders the diagnosis of CD in a childunder 2 years more accurate as regards differentiation from a healthy subject of from subject with a differententeropathy, while an error cannot be ruled out.

Key words:
coeliac sprue, endomysial antibodies, HLA haplotypes