Arató András, Körner Anna, Veres Gábor, Dezsöfi Antal, Ujpál Ildikó, Madácsy László
1st Department of Paediatrics, Semmelweis University, Bókay János u. 53, 1083 Budapest, Hungary.
Eur J Pediatr. 2003 Jan;162(1):1-5. doi: 10.1007/s00431-002-1103-9. Epub 2002 Nov 14.
Coeliac disease and type 1 diabetes mellitus can frequently coexist, presumably due to a common genetic predisposition. The present study was designed to evaluate the frequency of coeliac disease among Hungarian diabetic children and to study the effect of gluten-free diet on glycaemic control. A total of 205 diabetic children (age range 2.0-17.0 years, median 11.6 years) were screened for coeliac disease by determination of IgA-endomysium (EMA) antibodies. In the positive cases, a jejunal biopsy was performed and, in addition to routine histology, the number of intraepithelial gamma/delta T-cells was also determined. Insulin requirement, glycosylated haemoglobin level and body mass index of diabetic children with coeliac disease were determined before and 3 months after the introduction of gluten-free diet. IgA-EMA was positive in 24 cases, 17 of them (8.3% of all diabetic children) had a subtotal villous atrophy and thus coeliac disease was diagnosed. In all but two of these children, the mean number of gamma/delta T-cells was elevated (above 7 cells/mm). Of the remaining seven patients with positive EMA but normal villous structure, five (2.4%) had elevated number of epithelial gamma/delta T-cells, indicating probable latent coeliac disease. The insulin requirement of the children had significantly increased 3 months after the introduction of gluten-free diet (median values 0.64 versus 0.48 U/kg per day, P<0.05). Median body mass indices also showed significant elevation after this period (16.8 versus 14.2 kg/m(2), P<0.05) CONCLUSION: the frequency of coeliac disease was high in the studied group. Introduction of a gluten-free diet improved the somatic development of these children. A latent form of coeliac disease is also frequent in children with type 1 diabetes mellitus.
乳糜泻和1型糖尿病常可并存，可能是由于共同的遗传易感性。本研究旨在评估匈牙利糖尿病儿童中乳糜泻的发生率，并研究无麸质饮食对血糖控制的影响。通过检测IgA-肌内膜（EMA）抗体，对205名糖尿病儿童（年龄范围2.0 - 17.0岁，中位数11.6岁）进行乳糜泻筛查。对于阳性病例，进行空肠活检，除常规组织学检查外，还测定上皮内γ/δT细胞数量。在引入无麸质饮食前及3个月后，测定患有乳糜泻的糖尿病儿童的胰岛素需求量、糖化血红蛋白水平和体重指数。IgA-EMA阳性24例，其中17例（占所有糖尿病儿童的8.3%）有绒毛萎缩，从而诊断为乳糜泻。除两名儿童外，所有这些儿童的γ/δT细胞平均数量均升高（超过7个细胞/mm）。其余7例EMA阳性但绒毛结构正常的患者中，5例（2.4%）上皮γ/δT细胞数量升高，提示可能为潜在乳糜泻。引入无麸质饮食3个月后，儿童的胰岛素需求量显著增加（中位数分别为0.64对0.48 U/kg per day，P<0.05）。此期后体重指数中位数也显著升高（16.8对14.2 kg/m²，P<0.05）。结论：研究组中乳糜泻发生率较高。引入无麸质饮食改善了这些儿童的身体发育。1型糖尿病儿童中潜在形式的乳糜泻也很常见。
