Occurrence of celiac disease after onset of type 1 diabetes: A 6-year prospective longitudinal study
Occurrence of celiac disease after onset of type 1 diabetes: A 6-year prospective longitudinal study
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DOI：
10.1542/peds.109.5.833
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发表时间：
2002-05-01
期刊：
影响因子：
8
通讯作者：
Chiumello, G
中科院分区：
文献类型：
--
作者：
Barera, G;Bonfanti, R;Chiumello, G
Objective.研究1型糖尿病发病时儿童和青少年乳糜泻的患病率以及6年随访期间新发病例的发生率。我们前瞻性研究了274例连续6年的1型糖尿病患者（年龄[平均值+/-标准差]：8.28 +/- 4.65岁），通过重复血清学筛查。1例患者在糖尿病发作前诊断为乳糜泻。选择免疫球蛋白A-抗肌内膜抗体试验作为筛选试验;阳性结果（++或+）或连续2次弱阳性试验（+）的患者被认为适合进行空肠活检。在糖尿病发作时，273例患者中有15例（5.5%）抗肌内膜试验阳性; 10例进行空肠活检，9例诊断为乳糜泻。以糖尿病为表现的经活检证实的乳糜泻的患病率为3.6%（10/274例患者）。另外12名在糖尿病发作时抗肌内膜抗体检测阴性的患者在4年内的随访中检测为阳性;其中10名进行了活检，7名患有乳糜泻。因此，整个患者队列中活检证实的乳糜泻的总体患病率为6.2%。有和无乳糜泻患者的糖尿病发病年龄无差异（7.88 ± 5.69 vs 8.3 ± 4.58岁）。大多数乳糜泻病例的临床表现无症状，没有明显营养不良的迹象。1型糖尿病患者中乳糜泻的患病率比一般人群高约20倍。60%的病例在糖尿病发作时就已经存在，大多数未被发现，但另外40%的患者在糖尿病发作后几年发展为乳糜泻。建议在1型糖尿病发作后延长乳糜泻筛查计划，即使没有临床症状。
Objective. To investigate the prevalence of celiac disease in a large cohort of children and adolescents at the onset of type 1 diabetes and the occurrence of new cases during a 6-year follow-up.Methods. We prospectively studied, by repeated serologic screening, 274 consecutive patients at the onset of type 1 diabetes (age [mean +/- standard deviation]: 8.28 +/- 4.65 years) for 6 subsequent years. One patient had a diagnosis of celiac disease before the onset of diabetes. The immunoglobulin A-antiendomysium antibody test was selected as the screening test; patients with positive results (++ or +++) or with 2 consecutive weak positive tests (+) were considered appropriate for the jejunal biopsy.Results. At diabetes onset, 15 (5.5%) of 273 patients tested positive with the antiendomysium test; jejunal biopsy was performed in 10, and celiac disease was diagnosed in 9. The prevalence of biopsy-confirmed celiac disease at the manifestation of diabetes was 3.6% (10 of 274 patients). Twelve more patients with a negative antiendomysium antibody test at diabetes onset tested positive during the follow-up within 4 years; 10 of them had biopsies performed, and 7 had celiac disease. Therefore, the overall prevalence of biopsy-confirmed celiac disease in the entire cohort of patients was 6.2%. The age at diabetes onset in patients with and without celiac disease was not different (7.88 +/- 5.69 vs 8.3 +/- 4.58 years). The majority of cases of celiac disease were asymptomatic in their presentation, and no signs of overt malnutrition were documented.Conclusions. The prevalence of celiac disease in patients with type 1 diabetes is approximately 20 times higher than in the general population. Sixty percent of cases are already present at diabetes onset, mostly undetected, but an additional 40% of patients develop celiac disease a few years after diabetes onset. Extending screening programs for celiac disease after the onset of type 1 diabetes is recommended, even in the absence of clinical symptoms.