Introduction of Gluten, HLA Status, and the Risk of Celiac Disease in Children
Introduction of Gluten, HLA Status, and the Risk of Celiac Disease in Children
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DOI：
10.1056/nejmoa1400697
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发表时间：
2014-10-02
影响因子：
158.5
通讯作者：
Catassi, Carlo
中科院分区：
文献类型：
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作者：
Lionetti, Elena;Castellaneta, Stefania;Catassi, Carlo
乳糜泻的风险之间的关系和年龄在面筋被引入到一个孩子的饮食和一个孩子的早期饮食模式是unclear.METHODSWe随机分配832新生儿谁有一级亲属与乳糜泻的介绍，在6个月（A组）或12个月（组B）的饮食面筋。HLA基因型在15个月大时确定，乳糜泻的血清学筛查在15、24、36个月和5、8、10岁时进行评价。血清学检查阳性的患者进行肠活检。主要结果是5岁儿童中乳糜泻自身免疫和明显乳糜泻的患病率。在36个月时仍留在试验中的707名参与者中，553名具有标准风险或高风险HLA基因型并完成了研究。在2岁时，A组中患乳糜泻自身免疫性疾病（16% vs. 7%，P = 0.002）和明显乳糜泻（12% vs. 5%，P = 0.01）的儿童比例显著高于B组。5岁时，自身免疫（A组为21%，B组为20%，P = 0.59）或明显疾病（16%和16%，对数秩检验P = 0.78）的组间差异不再显著。在10年时，高风险HLA儿童的乳糜泻自身免疫风险远高于标准风险HLA儿童（38% vs. 19%，P = 0.001），明显乳糜泻的风险也是如此（26% vs. 16%，P = 0.05）。其他变量，包括母乳喂养，与乳糜泻diseases. CONCLUSIONSN的发展，无论是延迟引进的面筋，也不是母乳喂养修改的风险乳糜泻在高危婴儿，虽然后来引进面筋与延迟发病的疾病。高危HLA基因型是疾病的重要预测因子。（由意大利乳糜泻协会的Fondazione Celiachia资助; CELIPREV ClinicalTrials.gov编号，NCT 00639444。
BACKGROUNDThe relationship between the risk of celiac disease and both the age at which gluten is introduced to a child's diet and a child's early dietary pattern is unclear.METHODSWe randomly assigned 832 newborns who had a first-degree relative with celiac disease to the introduction of dietary gluten at 6 months (group A) or 12 months (group B). The HLA genotype was determined at 15 months of age, and serologic screening for celiac disease was evaluated at 15, 24, and 36 months and at 5, 8, and 10 years. Patients with positive serologic findings underwent intestinal biopsies. The primary outcome was the prevalence of celiac disease autoimmunity and of overt celiac disease among the children at 5 years of age.RESULTSOf the 707 participants who remained in the trial at 36 months, 553 had a standard-risk or high-risk HLA genotype and completed the study. At 2 years of age, significantly higher proportions of children in group A than in group B had celiac disease autoimmunity (16% vs. 7%, P = 0.002) and overt celiac disease (12% vs. 5%, P = 0.01). At 5 years of age, the between-group differences were no longer significant for autoimmunity (21% in group A and 20% in group B, P = 0.59) or overt disease (16% and 16%, P = 0.78 by the log-rank test). At 10 years, the risk of celiac disease autoimmunity was far higher among children with high-risk HLA than among those with standard-risk HLA (38% vs. 19%, P = 0.001), as was the risk of overt celiac disease (26% vs. 16%, P = 0.05). Other variables, including breast-feeding, were not associated with the development of celiac disease.CONCLUSIONSNeither the delayed introduction of gluten nor breast-feeding modified the risk of celiac disease among at-risk infants, although the later introduction of gluten was associated with a delayed onset of disease. A high-risk HLA genotype was an important predictor of disease. (Funded by the Fondazione Celiachia of the Italian Society for Celiac Disease; CELIPREV ClinicalTrials.gov number, NCT00639444.)