Clinical Features of Celiac Disease: A Prospective Birth Cohort
Clinical Features of Celiac Disease: A Prospective Birth Cohort
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DOI：
10.1542/peds.2014-3675
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发表时间：
2015-04-01
期刊：
影响因子：
8
通讯作者：
Koletzko, Sibylle
中科院分区：
文献类型：
--
作者：
Agardh, Daniel;Lee, Hye-Seung;Koletzko, Sibylle
目的：研究乳糜泻（CD）的临床特征及其与CD遗传风险出生队列中危险因素的相关性。方法：来自4个国家6个临床中心的HLA-DR 3-DQ 2或DR 4-DQ 8阳性儿童每年进行组织转氨酶抗体（tTGA）筛查，并通过问卷调查评估症状。症状与人体测量学，已知的CD，tTGA水平的危险因素，粘膜病变的活检examined.RESULTS：6706筛选儿童，914开发持续阳性tTGA，406进行活检，340 CD。与年龄匹配的tTGA阴性儿童相比，持续性tTGA儿童更可能在2岁（34% vs 19%，P <0.001）和3岁（28% vs 19%，P = 0.009）时出现症状，但在4岁时则没有（27% vs 21%，NS）。两组之间的身高、体重和BMI的Z评分没有差异。在患有持续性tTGA的儿童中，有>= 1个症状与CD家族史相关（比值比= 2.59，95%置信区间为1.21-5.57），但与年龄、性别或HLA-DR 3-DQ 2纯合性无关。在血清转换时，有症状儿童的tTGA水平高于无症状儿童（P <0.001），CD家族儿童（P <0.001）和美国参与者（P <0.001），但与年龄、性别或HLA基因型无关。tTGA水平与有症状儿童（r = 0.53，P <0.001）和无症状儿童（r = 0.22，P = 0.01）的粘膜病变严重程度相关。结论：筛查中检测到持续性tTGA的大多数儿童无症状，到4岁时生长正常。与无症状儿童相比，有症状儿童的tTGA水平与粘膜病变的严重程度相关性更强。
OBJECTIVES: To investigate clinical features of celiac disease (CD) and their association with risk factors for CD in a genetic risk birth cohort.METHODS: Children from 6 clinical centers in 4 countries positive for HLA-DR3-DQ2 or DR4-DQ8 were annually screened for tissue transglutaminase antibodies (tTGA) and assessed for symptoms by questionnaires. Associations of symptoms with anthropometrics, known risk factors for CD, tTGA levels, and mucosal lesions in those biopsied were examined.RESULTS: Of 6706 screened children, 914 developed persistent positive tTGA, 406 underwent biopsies, and 340 had CD. Compared with age-matched tTGA-negative children, those with persistent tTGA were more likely to have symptoms at 2 (34% vs 19%, P < .001) and 3 years of age (28% vs 19%, P = .009) but not at 4 years (27% vs 21%, NS). Z-scores for height, weight, and BMI did not differ between groups. In children with persistent tTGA, having >= 1 symptom was associated with family history of CD (odds ratio = 2.59, 95% confidence interval, 1.21-5.57) but not with age, gender, or HLA-DR3-DQ2 homozygosity. At seroconversion, tTGA levels were higher in symptomatic than asymptomatic children (P < .001), in those from CD families (P < .001), and in US participants (P < .001) but not associated with age, gender, or HLA genotype. tTGA levels correlated with severity of mucosal lesions both in symptomatic (r = 0.53, P < .001) and asymptomatic children (r = 0.22, P = .01).CONCLUSIONS: A majority of children detected with persistent tTGA in screenings are asymptomatic and have normal growth by age 4 years. tTGA levels correlate more strongly with severity of mucosal lesions in symptomatic as compared with asymptomatic children.