Valerio G, Maiuri L, Troncone R, Buono P, Lombardi F, Palmieri R, Franzese A
Faculty of Motoric Sciences, University Parthenope, Naples, Italy.
Diabetologia. 2002 Dec;45(12):1719-22. doi: 10.1007/s00125-002-0923-5. Epub 2002 Oct 19.
AIMS/HYPOTHESIS: To analyse whether the time of diagnosis of coeliac disease with respect to the clinical onset of diabetes could differentiate subgroups of varying severity in patients with both diseases.
We investigated 383 patients with Type I (insulin-dependent) diabetes mellitus for coeliac disease. Sex distribution, age at diagnosis of diabetes, prevalence of ketoacidosis at the onset of diabetes and prevalence of other autoimmune diseases were compared in patients. We divided these patients according to whether coeliac disease was diagnosed before (Group A, n=8) or after (Group B, n=24) diabetes onset and whether they had presented clinical symptoms of coeliac disease. Group C (n=351) included diabetic patients without coeliac disease.
Out of 383 Type I diabetic patients we found 32 coeliac subjects (8.3%). There was a higher number of girls (p=0.003), but similar age and prevalence of ketoacidosis compared with Group C; 18.7% had a third autoimmune disorder. The higher number of girls was confirmed in Groups A and B in comparison to Group C (p=0.013), while higher prevalence of both ketoacidosis (p=0.009) and other autoimmune diseases (p=0.001) was found only in Group A. Compared with symptomatic patients, asymptomatic subjects in Group B had a lower number of girls, older age at diabetes onset, lower prevalence of ketoacidosis and no other associated autoimmune disease.
CONCLUSIONS/INTERPRETATION: A wide clinical spectrum characterises the association of coeliac disease and diabetes mellitus, with a severe clinical presentation (higher prevalence of ketoacidosis at the onset and occurrence of other autoimmune diseases) when coeliac disease is diagnosed before diabetes. Distinct phenotypes might imply the contribution of a peculiar genetic background.
目的/假设：分析乳糜泻的诊断时间相对于糖尿病临床发病时间，是否能区分同时患有这两种疾病的不同严重程度亚组。
我们调查了383例1型（胰岛素依赖型）糖尿病患者是否患有乳糜泻。比较了患者的性别分布、糖尿病诊断年龄、糖尿病发病时酮症酸中毒的患病率以及其他自身免疫性疾病的患病率。我们根据乳糜泻是在糖尿病发病前（A组，n = 8）还是发病后（B组，n = 24）被诊断出来，以及他们是否出现了乳糜泻的临床症状，将这些患者进行了分组。C组（n = 351）包括无乳糜泻的糖尿病患者。
在383例1型糖尿病患者中，我们发现32例乳糜泻患者（8.3%）。与C组相比，女孩数量更多（p = 0.003），但年龄和酮症酸中毒患病率相似；18.7%的患者患有第三种自身免疫性疾病。与C组相比，A组和B组中女孩数量更多得到了证实（p = 0.013），而仅在A组中发现酮症酸中毒（p = 0.009）和其他自身免疫性疾病（p = 0.001）的患病率更高。与有症状的患者相比，B组无症状患者的女孩数量更少、糖尿病发病年龄更大、酮症酸中毒患病率更低且无其他相关自身免疫性疾病。
结论/解读：乳糜泻和糖尿病的关联具有广泛的临床谱，当乳糜泻在糖尿病之前被诊断时，临床表现较为严重（发病时酮症酸中毒患病率更高且出现其他自身免疫性疾病）。不同的表型可能意味着特殊遗传背景的作用。
