Prevalence of celiac disease in at-risk and not-at-risk groups in the United States - A large multicenter study
Prevalence of celiac disease in at-risk and not-at-risk groups in the United States - A large multicenter study
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DOI：
10.1001/archinte.163.3.286
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发表时间：
2003-02-10
影响因子：
--
通讯作者：
Horvath, K
中科院分区：
文献类型：
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作者：
Fasano, A;Berti, I;Horvath, K
背景：乳糜泻(CD)是一种免疫介导的肠道疾病，由摄入面筋引起遗传易感人群。虽然CD在欧洲很常见，但在美国被认为是罕见的，那里没有关于其流行率的大型流行病学研究。本研究的目的是确定CD在美国高危人群和非高危人群中的患病率。方法：检测血清抗Ghadin抗体和抗内膜肌抗体(EMA)。在EMA阳性的受试者中，检测了人类组织转谷氨酰胺酶IgA抗体和CD相关人类白细胞抗原DQ2/DQ8单倍型。建议对所有EMA阳性受试者尽可能地进行肠道活组织检查。结果：高危人群中CD的患病率分别为1：22、1：39、1：56。非高危人群中CD的总体患病率为1：133。所有接受肠道活检的EMA阳性受试者的病变均与CD一致。结论：CD不仅在有胃肠道症状的患者中常见，而且在一、二级亲属和许多常见疾病的患者中也常见，即使没有胃肠道症状也是如此。在有症状的患者和非高危人群中，CD的患病率与欧洲的报告相似。乳糜泻似乎是一种比美国普遍认识的更常见但被忽视的疾病。
Background: Celiac disease (CD) is an immune-mediated enteropathic condition triggered in genetically susceptible individuals by the ingestion of gluten. Although common in Europe, CD is thought to be rare in the United States, where there are no large epidemiologic studies of its prevalence. The aim of this study was to determine the prevalence of CD in at-risk and not-at-risk groups in the United States.Methods: Serum antighadin antibodies and anti-endomysial antibodies (EMA) were measured. In EMA-positive subjects, human tissue transglutaminase IgA antibodies and CD-associated human leukocyte antigen DQ2/DQ8 haplotypes were determined. Intestinal biopsy was recommended and performed whenever possible for all EMA-positive subjects. A total of 13 145 subjects were screened: 4508 first-degree and 1275 second-degree relatives of patients with biopsy-proven CD, 3236 symptomatic patients (with either gastrointestinal symptoms or a disorder associated with CD), and 4126 not-at-risk individuals.Results: In at-risk groups, the prevalence of CD was 1:22 in first-degree relatives, 1:39 in second-degree relatives, and 1:56 in symptomatic patients. The overall prevalence of CD in not-at-risk groups was 1: 133. All the EMA-positive subjects who underwent intestinal biopsy had lesions consistent with CD.Conclusions: Our results suggest that CD occurs frequently not only in patients with gastrointestinal symptoms, but also in first- and second-degree relatives and patients with numerous common disorders even in the absence of gastrointestinal symptoms. The prevalence of CD in symptomatic patients and not-at-risk subjects was similar to that reported in Europe. Celiac disease appears to be a more common but neglected disorder than has generally been recognized in the United States.