Incidence of autoimmune diseases in celiac disease: Protective effect of the gluten-free diet
Incidence of autoimmune diseases in celiac disease: Protective effect of the gluten-free diet
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DOI：
10.1016/j.cgh.2007.12.022
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发表时间：
2008-07-01
影响因子：
12.6
通讯作者：
Nion-Larmurier, Isabelle
中科院分区：
文献类型：
--
作者：
Cosnes, Jacques;Cellier, Christophe;Nion-Larmurier, Isabelle
背景与目的：乳糜泻可能与自身免疫性疾病有关。本研究的目的是确定乳糜泻患者中哪些因素调节自身免疫性疾病的风险，并评估无麸质饮食的效果。研究方法：回顾性研究了从27个法国儿科和成人胃肠病中心招募的924名乳糜泻患者的自身免疫性疾病发生率和对无麸质饮食的依从性。结果：178例患者均合并一种或多种自身免疫性疾病。自身免疫性疾病的累积风险在15岁时为8.1% ± 1%，在30岁时为15.7% ± 1.5%。与风险增加相关的因素是自身免疫家族史（风险比，2.36; 95%置信区间，1.71-3.31）和36岁以前诊断为乳糜泻（风险比，2.65; 95%置信区间，1.79-3.85）。在诊断为乳糜泻后，788例患者中有55例发展为自身免疫性疾病。与不依从无麸质饮食的患者相比，依从无麸质饮食的患者随后发生自身免疫性疾病的累积风险较低（10年时，分别为6% +/- 2% vs 15.6% +/-5.9%; P = 0.02）。在坚持无麸质饮食期间，自身免疫性疾病的发病率为5.4/1000患者-年，而在不坚持饮食期间为11.3/1000患者-年（P =.002）。儿童和成人人群的结果相似。结论：乳糜泻患者最易患自身免疫性疾病的是那些在生命早期被诊断出的，并且有自身免疫性家族史的患者。无麸质饮食具有保护作用。
Background & Aims: Celiac disease may be associated with autoimmune diseases. The aims of the present study were to determine in celiac patients which factors modulate the risk of autoimmune disease and to evaluate the effect of the gluten-free diet. Methods: The occurrence of autoimmune disease and compliance to gluten-free diet were specified retrospectively in 924 celiac patients recruited from 27 French pediatric and adult gastroenterology centers. Results: One or several autoimmune diseases had developed in 178 patients. The cumulative risk of autoimmune disease was 8.1% +/- 1% at age 15, and 15.7% +/- 1.5% at age 30. Factors associated with an increased risk were family history of autoimmunity (hazard ratio, 2.36; 95% confidence interval, 1.71-3.31) and diagnosis of celiac disease before 36 years of age (hazard ratio, 2.65; 95% confidence interval, 1.79-3.85). After diagnosis of celiac disease, 55 of 788 patients developed an autoimmune disease. The cumulative risk of subsequent autoimmune disease was lower in patients compliant to a gluten-free diet versus noncompliant patients (at 10 years, 6% +/- 2% vs 15.6% +/- 5.9%, respectively; P =.02). The incidence of autoimmune diseases was 5.4 per 1000 patient-years during adherence to a gluten-free diet versus 11.3 per 1000 patient-years during nonadherence to the diet (P =.002). Results were similar in both the pediatric and the adult populations. Conclusions: Celiac patients most at risk for autoimmune disease are those diagnosed early in life and having a family history of autoimmunity. The gluten-free diet has a protective effect.