Autism spectrum disorders (ASD) are neurodevelopmental disorders characterized by impaired social interaction and communication, as well as repetitive behavior and restricted interests. There is convincing evidence that the intestinal inflammation is involved in etiology of ASD. Increased levels of inflammatory markers were shown to be associated with more aberrant behaviors and communication of subjects with ASD. Calprotectin in the feces is produced by activated neutrophils and epithelial cells of the gut mucosa, and its levels reflect local inflammation of the gastrointestinal tract. Concentration of fecal calprotectin was determined by ELISA method in 87 individuals with ASD and 51 controls, of that 29 siblings of children with ASD and 22 non-related controls. In non-relatives significantly lower values of fecal calprotectin were observed than in both subjects with ASD and their siblings. In the group with ASD significant correlations of fecal calprotectin with all domains of the ADI-R diagnostic tool were found: qualitative abnormalities in reciprocal social interaction and communication, restrictive and repetitive patterns of behavior. Results suggest that low grade intestinal inflammation may be one of factors implicated in the pathophysiology of ASD.
Autoři představují dvě metody tzv. zlatého standardu v diagnostice poruch autistického spektra: diagnostický rozhovor ADI-R (Autism Diagnostic Interview - Revised) a observační metodu ADOS (Autism Diagnostic Observation Schedule) a přinášejí přehled porovnávacích studií obou nástrojů. Některé studie nalezly diagnostickou ekvivalenci obou nástrojů zlatého standardu, některé studie mírně favorizovaly ADOS. Senzitivita obou nástrojů je i při jejich samostatném užití vysoká. Kombinované užití ADI-R a ADOS vede k přesnějším výsledkům především v oblasti specificity. Autoři presentují dvě kazuistiky paralelního klinického užití nástrojů ADI-R a ADOS v diagnostice dvou chlapců ve věku 8,8 a 4,2 let. Oba případy dobře dokumentují teoretický předpoklad, že zatímco v optimálních podmínkách je spolehlivost obou metod srovnatelná, pak tam, kde je spolupráce rodiče či pečovatele jakkoli nespolehlivá, omezená či dokonce nemožná, je užití ADI-R významně limitováno a přednost má vyšetření nástrojem ADOS., The authors discuss two “gold standard” methods for the diagnosis of autism spectrum disorders: ADI-R (Autism Diagnostic Interview - Revised) and ADOS (Autism Diagnostic Observation Schedule), and review comparative studies that evaluate the methods. Some of the studies found the instruments to be diagnostically equivalent, other studies slightly favored ADOS. Sensitivity of both methods was high even when used alone. However, the combined use of ADI-R and ADOS led to higher diagnostic specificity. The authors also present two cases describing the parallel clinical use of ADI-R and ADOS as part of the diagnosis of two boys aged 8.8 and 4.2 years, respectively. Both cases effectively demonstrate the following theoretical assumption: whereas the reliability of both methods is comparable under optimal conditions, the use of ADI-R is significantly limited in cases when the cooperation of the parent(s) or caregiver is unreliable, limited, or impossible. In such cases, examination using ADOS is preferred., and Iva Dudová, Michal Hrdlička.