Increasing Incidence and Altered Presentation in a Population-based Study of Pediatric Celiac Disease in North America.
Increasing Incidence and Altered Presentation in a Population-based Study of Pediatric Celiac Disease in North America.
复制标题
DOI：
10.1097/mpg.0000000000001532
复制
发表时间：
2017-10
影响因子：
2.9
通讯作者：
Absah I
中科院分区：
文献类型：
--
作者：
Almallouhi E;King KS;Patel B;Wi C;Juhn YJ;Murray JA;Absah I
乳糜泻 (CD) 是一种常见的免疫介导疾病，影响高达 1% 的总人口。最近的报告表明，CD 的发病率在许多国家已达到稳定水平。我们的目标是研究明确人群中儿童 CD 的发病率和表现变化。利用罗切斯特流行病学项目，我们回顾性审查了梅奥诊所和奥姆斯特德医疗中心 1994 年 1 月至 2014 年 12 月的医疗记录。我们确定了诊断时年龄为 18 岁或以下的患者的所有 CD 病例。发病率的计算方法是调整年龄、性别和日历年份，并以 2010 年美国白人人口为标准进行标准化。我们确定了 100 名 CD 患者。 CD 的发病率从每 10 万人年 8.1 例（2000-2002 年）增加到每 10 万人年 21.5 例（2011-2014 年）。从 2010 年（0.10%）到 2014 年（0.17%），儿童 CD 患病率有所增加。 34 例（34%）患者出现经典 CD 症状，43 例（43%）患者出现非经典 CD 症状，23 例（23%）通过筛查无症状高危患者确诊。 36例（36%）绒毛完全萎缩，51例（51%）部分萎缩，11例（11%）上皮内淋巴细胞增多。两名患者未经活检即被诊断。大多数患者 (67%) 体重指数正常，17% 超重/肥胖，只有 9% 体重不足。过去 15 年来，明尼苏达州奥姆斯特德县儿童 CD 的发病率和患病率持续增加。 CD 的临床和病理表现随着时间的推移而发生变化（更多非经典和无症状病例不断出现）。
Celiac disease (CD) is a common immune-mediated disorder that affects up to 1% of the general population. Recent reports suggest that the incidence of CD has reached a plateau in many countries. We aim to study the incidence and altered presentation of childhood CD in a well-defined population. Using the Rochester Epidemiology Project, we retrospectively reviewed Mayo Clinic and Olmsted Medical Center medical records from January 1994 to December 2014. We identified all CD cases of patients aged 18 or younger at the time of diagnosis. Incidence rates were calculated by adjusting for age, sex, and calendar year and standardizing to the 2010 US white population. We identified 100 patients with CD. Incidence of CD has increased from 8.1 per 100,000 person-years (2000–2002) to 21.5 per 100,000 person-years (2011–2014). There was an increase in CD prevalence in children from 2010 (0.10%) to 2014 (0.17%). Thirty-four patients (34%) presented with classical CD symptoms, 43(43%) had non-classical CD, and 23(23%) were diagnosed by screening asymptomatic high-risk patients. Thirty-six patients (36%) had complete villous atrophy, 51 (51%) had partial atrophy, 11 (11%) had increased intraepithelial lymphocytes. Two patients were diagnosed without biopsy. Most patients (67%) had a normal body mass index, 17% were overweight/obese and only 9% were underweight. Both incidence and prevalence of CD have continued to increase in children over the past 15 years in Olmsted County, Minnesota. Clinical and pathologic presentations of CD are changing over time (more non-classical and asymptomatic cases are emerging).