背景:当无麸质饮食(GFD)在诊断检查之前开始时,乳糜泻(CD)和非乳糜泻麸质敏感性(NCGS)患者之间的鉴别诊断是困难的。在这种具有挑战性的临床环境中,TCRγδ和腹腔淋巴图的单独增加(TCRγδ增加加上CD3-减少)可能使鉴别诊断成为可能。这项研究评估了:(1)%TCRγδ和乳糜泻在GFD之前和之后诊断CD以及与NCGS区分的准确性;(2)CD和NCGS中基线和开始GFD后的TCRγδ动力学。
方法:纳入标准为CD患者(n=104),NCGS(n=37),和健康志愿者(n=18)。在基线和GFD后通过流式细胞术对上皮内淋巴图进行肠活检。通过最大化Youden指数并通过逻辑回归来建立CD诊断准确性的最佳截止值。
结果:%TCRγδ+在GFD开始之前和之后识别CD的诊断准确性优于腹腔淋巴图。截止值>13.31时,诊断GFD患者CD的准确性为0.88[0.80-0.93],而诊断NCGS(%TCRγδ+≤13.31)的准确率为0.84[0.76-0.89]。TCRγδ+细胞的百分比显示CD之间的差异动力学(基线22.7%[IQR,16.4-33.6]vs.GFD26.4%后[IQR,17.8-36.8];p=0.026)和NCGS(基线9.4%[IQR,4.1-14.6]vs.GFD6.4%后[IQR,3.2-11];p=0.022)。
结论:TCRγδ+T细胞评估可准确诊断GFD前后的CD。在CD中GFD后长期维持增加的TCRγδ+,但在NCGS中没有。总之,这表明该标记对于GFD患者中这两种实体的鉴别诊断具有潜在的价值.
BACKGROUND: The differential diagnosis between patients with celiac disease (CD) and non-celiac gluten sensitivity (NCGS) is difficult when a gluten-free diet (GFD) has been initiated before the diagnostic work-up. Isolated increases in TCRγδ+ and celiac lymphogram (increased TCRγδ+ plus decreased CD3-) may enable differential diagnosis in this challenging clinical setting. This study evaluated: (1) the accuracy of %TCRγδ+ and celiac lymphogram for diagnosing CD before and after GFD and for differentiation with NCGS; (2) TCRγδ+ kinetics at baseline and after starting GFD in both CD and NCGS.
METHODS: The inclusion criteria were patients with CD (n = 104), NCGS (n = 37), and healthy volunteers (n = 18). An intestinal biopsy for intraepithelial lymphogram by flow cytometry was performed at baseline and after GFD. The optimal cutoff for CD diagnostic accuracy was established by maximizing the Youden index and via logistic regression.
RESULTS: %TCRγδ+ showed better diagnostic accuracy than celiac lymphogram for identifying CD before and after GFD initiation. With a cutoff > 13.31, the accuracy for diagnosing CD in patients under GFD was 0.88 [0.80-0.93], whereas the accuracy for diagnosing NCGS (%TCRγδ+ ≤ 13.31) was 0.84 [0.76-0.89]. The percentage of TCRγδ+ cells showed differential kinetics between CD (baseline 22.7% [IQR, 16.4-33.6] vs. after GFD 26.4% [IQR, 17.8-36.8]; p = 0.026) and NCGS (baseline 9.4% [IQR, 4.1-14.6] vs. after GFD 6.4% [IQR, 3.2-11]; p = 0.022).
CONCLUSIONS: TCRγδ+ T cell assessment accurately diagnoses CD before and after a GFD. Increased TCRγδ+ was maintained in the long term after GFD in CD but not in NCGS. Altogether, this suggests the potential usefulness of this marker for the differential diagnosis of these two entities in patients on a GFD.