Natural history of celiac disease autoimmunity in a USA cohort followed since 1974
Natural history of celiac disease autoimmunity in a USA cohort followed since 1974
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DOI：
10.3109/07853890.2010.514285
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发表时间：
2010-10-01
影响因子：
4.4
通讯作者：
Fasano, Alessio
中科院分区：
文献类型：
--
作者：
Catassi, Carlo;Kryszak, Debby;Fasano, Alessio
背景。乳糜泻（CD）患病率的自然历史和可能随时间的变化仍不清楚。1)确定是否在任何年龄都可能发生麸质耐受性丧失；2)调查乳糜泻患病率随时间可能发生的变化；3)调查cd相关合并症。我们分析了1974年（CLUE I）和1989年（CLUE II）匹配样本的3,511名受试者。为了避免关于生存的选择偏差，我们还筛选了840名在1974年调查后死亡的CLUE I参与者。测量结果。随着时间的推移，乳糜泻自身免疫（自身抗体阳性）。1974年在7名受试者中检测到乳糜泻自身免疫（患病率1:501），1989年在另外9名受试者中检测到乳糜泻自身免疫（患病率1:19 19）。在CLUE 1治疗后死亡的840名受试者中，发现2例乳糜泻自身免疫。与对照组相比，未经治疗的乳糜泻患者骨质疏松症和相关自身免疫性疾病的发生率增加，但没有达到统计学意义。自1974年以来，在15年期间，CLUE队列的CD患病率增加了2倍，美国的总体患病率增加了5倍。CLUE研究表明，这种增加是由于越来越多的受试者在成年后失去了对谷蛋白的免疫耐受性。
Background. The natural history and the possible changes of celiac disease (CD) prevalence over time are still unclear.Objectives. 1) To establish whether loss of tolerance to gluten may occur at any age; 2) to investigate possible changes of CD prevalence over time; and 3) to investigate CD-related co-morbidities.Methods. We analyzed 3,511 subjects with matched samples from 1974 (CLUE I) and 1989 (CLUE II). To avoid a selection bias regarding survival, we also screened 840 CLUE I participants who deceased after the 1974 survey.Outcome measure. CD autoimmunity (positivity to auto-antibodies) over time.Results. CD autoimmunity was detected in seven subjects in 1974 (prevalence 1:501) and in an additional nine subjects in 1989 (prevalence 1:219). Two cases of CD autoimmunity were found among the 840 subjects deceased after CLUE I. Compared to controls, untreated CD subjects showed increased incidence of osteoporosis and associated autoimmune disorders, but they did not reach statistical significance.Conclusions. During a 15-year period CD prevalence increased 2-fold in the CLUE cohort and 5-fold overall in the US since 1974. The CLUE study demonstrated that this increase was due to an increasing number of subjects that lost the immunological tolerance to gluten in their adulthood.