Prevalence and Morbidity of Undiagnosed Celiac Disease From a Community-Based Study.
Prevalence and Morbidity of Undiagnosed Celiac Disease From a Community-Based Study.
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DOI：
10.1053/j.gastro.2016.11.043
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发表时间：
2017-03
期刊：
影响因子：
29.4
通讯作者：
Murray JA
中科院分区：
文献类型：
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作者：
Choung RS;Larson SA;Khaleghi S;Rubio-Tapia A;Ovsyannikova IG;King KS;Larson JJ;Lahr BD;Poland GA;Camilleri MJ;Murray JA
对于50岁以下人群中未确诊的乳糜泻的患病率和负担知之甚少。我们确定了一个社区中50岁以下人群中未确诊的乳糜泻的患病率和发病率。我们测试了来自明尼苏达州奥姆斯特德县的31，255名居民（年龄小于50岁）的血清，这些居民先前没有使用针对组织转氨酶（tTG）的免疫球蛋白A（伊加）测定法诊断乳糜泻;在具有阳性测试结果的受试者中，使用肌内膜伊加测定法确认乳糜泻。我们进行了一项巢式病例对照研究，以比较未确诊的乳糜泻病例与年龄和性别匹配的血清阴性对照之间的合并症比例（1：2）。提取病历以识别潜在合并症。我们确定了30,425名成人中的338名，两种血清学试验均呈阳性结果。基于这一发现，我们估计乳糜泻的患病率为1.1%（95% CI，1.0%-1.2%）; 830名儿童中有8名tTG伊加检测阳性（1.0%，95% CI，0.4%-1.9%）。未确诊的乳糜泻与确诊的乳糜泻无典型症状或典型后果（腹泻、贫血或骨折）。未确诊的乳糜泻与甲状腺功能减退症的发生率增加（比值比，2.2; P<0.01）以及胆固醇（P= 0.03）和铁蛋白（P= 0.01）低于平均水平相关。在平均6.3年的随访期内，在检测后5年，未确诊乳糜泻的患者随后诊断为乳糜泻的累积发生率为10.8%，血清阴性患者为0.1%（P<0.01）。乳糜泻状态与总生存率无关。根据对社区人群进行的乳糜泻血清学检测，我们估计未确诊乳糜泻的患病率为1%。未确诊的乳糜泻似乎在临床上是沉默的，仍然未被发现，但长期结果尚未确定。
Little is known about the prevalence and burden of undiagnosed celiac disease in individuals younger than 50 years old. We determined the prevalence and morbidity of undiagnosed celiac disease in individuals younger than 50 years in a community. We tested sera from 31,255 residents of Olmsted County, Minnesota (younger than 50 years old) without a prior diagnosis of celiac disease assay using an assay for immunoglobulin A (IgA) against tissue transglutaminase (tTG); in subjects with positive test results, celiac disease was confirmed using an assay for endomysial IgA. We performed a nested case–control study to compare the proportion of comorbidities between undiagnosed cases of celiac disease and age- and sex-matched seronegative controls (1:2). Medical records were abstracted to identify potential comorbidities. We identified 338 of 30,425 adults with positive results from both serologic tests. Based on this finding, we estimated the prevalence of celiac disease to be 1.1% (95% CI, 1.0%–1.2%); 8 of 830 children tested positive for IgA against tTG (1.0%, 95% CI, 0.4%–1.9%). No typical symptoms or classic consequences of diagnosed celiac disease (diarrhea, anemia, or fracture) were associated with undiagnosed celiac disease. Undiagnosed celiac disease was associated with increased rates of hypothyroidism (odds ratio, 2.2; P<.01) and lower than average level of cholesterol (P=.03) and ferritin (P=.01). During a median follow-up period of 6.3 years, the cumulative incidence of subsequent diagnosis with celiac disease at 5 years after testing was 10.8% in persons with undiagnosed celiac disease vs 0.1% in seronegative persons (P<.01). Celiac disease status was not associated with overall survival. Based on serologic tests of a community population for celiac disease, we estimated the prevalence of undiagnosed celiac disease to be 1%. Undiagnosed celiac disease appeared to be clinically silent and remained undetected, but long-term outcomes have not been determined.