Mortality in patients with coeliac disease and their relatives:: a cohort study
Mortality in patients with coeliac disease and their relatives:: a cohort study
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DOI：
10.1016/s0140-6736(01)05554-4
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发表时间：
2001-08-04
期刊：
影响因子：
168.9
通讯作者：
Certo, M
中科院分区：
文献类型：
--
作者：
Corrao, G;Corazza, GR;Certo, M
背景 尽管之前的研究表明乳糜泻患者及其亲属的死亡率增加，但没有与不同临床表现模式相关的数据。我们评估了乳糜泻患者及其一级亲属的死亡率。 方法 在一项前瞻性队列研究中，我们纳入了 1962 年至 1994 年间在 11 个胃肠病科连续诊断的 1072 名成年乳糜泻患者及其 3384 名一级亲属。我们将截至 1998 年的死亡人数与预期死亡人数进行了比较，并将比较结果表示为标准化死亡率 (SMR) 和相对生存比。结果显示，53 名乳糜泻患者死亡，而预期死亡人数为 25.9 人（SMR 2.0 [95% CI 1.5-2.7]）。乳糜泻诊断后的前 3 年以及出现吸收不良症状的患者 (2.5 [1.8-3.4]) 死亡率明显升高，但因轻微症状 (1.1 [0.5-2.2]) 或抗体筛查 (1.2 [0.1-7.0]) 而诊断的患者死亡率却没有明显升高。 SMR 随着诊断延迟的增加以及无麸质饮食依从性差的患者而增加。非霍奇金淋巴瘤是主要的死亡原因。患有乳糜泻的亲属中没有记录过多的死亡人数。解释。及时和严格的饮食治疗可降低乳糜泻患者的死亡率。需要前瞻性研究来阐明轻度或无症状乳糜泻的进展及其与肠道淋巴瘤的关系。
Background Although previous studies have shown increased mortality in patients with coeliac disease and their relatives, no data are available in relation to different patterns of clinical presentation. We assessed mortality in patients with coeliac disease and their first-degree relatives.Methods We enrolled, in a prospective cohort study, 1072 adult patients with coeliac disease consecutively diagnosed in 11 gastroenterology units between 1962 and 1994, and their 3384 first-degree relatives. We compared the number of deaths up to 1998 with expected deaths and expressed the comparison as standardised mortality ratio (SMR) and relative survival ratio.Findings 53 coeliac patients died compared with 25.9 expected deaths (SMR 2.0 [95% CI 1.5-2.7]). A significant excess of mortality was evident during the first 3 years after diagnosis of coeliac disease and in patients who presented with malabsorption symptoms (2.5 [1.8-3.4]), but not in those diagnosed because of minor symptoms (1.1 [0.5-2.2]) or because of antibody screening (1.2 [0.1-7.0]). SMR increased with increasing delay in diagnosis and for patients with poor compliance with gluten-free diet. Non-Hodgkin lymphoma was the main cause of death. No excess of deaths was recorded in relatives with coeliac disease.Interpretation. Prompt and strict dietary treatment decreases mortality in coeliac patients. Prospective studies are needed to clarify the progression of mild or symptomless coeliac disease and its relation to intestinal lymphoma.