Hanukoglu Aaron, Mizrachi Avraam, Dalal Ilan, Admoni Osnat, Rakover Yardena, Bistritzer Zvy, Levine Arie, Somekh Eli, Lehmann Dan, Tuval Myriam, Boaz Mona, Golander Avraham
Department of Pediatrics, E. Wolfson Medical Center, Holon and Sackler Faculty of Medicine, Tel-Aviv University, Tel-Aviv, Israel.
Diabetes Care. 2003 Apr;26(4):1235-40. doi: 10.2337/diacare.26.4.1235.
To investigate the prevalence of autoimmune diseases in young patients (probands) with type 1 diabetes and their first-degree relatives, and to determine the spectrum of extrapancreatic manifestations in these subjects.
The study population included 109 probands age 13 +/- 4.9 years and 412 first-degree relatives age 28.7 +/- 16.2 years. The prevalence rates of autoimmune thyroiditis and celiac disease were determined in all probands and in 100 of the 412 first-degree relatives. Control groups included 78 subjects age 14.9 +/- 10.4 years for the prevalence of autoimmune thyroiditis and 120,000 youth ages 16-17 years for the prevalence of celiac disease. Thyroiditis and celiac disease were diagnosed by abnormally high thyroid peroxidase (TPO), thyroglobulin (TG), antigliadin, and antiendomysial antibody titers. Celiac was confirmed by biopsy. A questionnaire was used to interview probands and relatives to determine the spectrum of autoimmune manifestations.
The prevalence of autoimmune thyroiditis determined by high TPO and/or TG titers was 27 and 25% for probands and relatives, respectively. These rates were higher than those for control subjects (P < 000.1). The prevalence of celiac disease among probands and screened relatives was 8.3 and 6%, respectively. These rates were higher than those for control subjects and the 312 family members interviewed only (0.1 and 0.3%, respectively; P < 0.0001). Interviews of participants revealed a wide range of associated autoimmune diseases. The risk of developing an autoimmune disease was higher (P < 0.001) in families with a proband who had an additional autoimmune manifestation.
Screening for autoimmune thyroiditis and celiac disease should be performed in patients with type 1 diabetes and their first-degree relatives, especially when the probands have an additional autoimmune manifestation.
调查1型糖尿病年轻患者（先证者）及其一级亲属自身免疫性疾病的患病率，并确定这些受试者胰腺外表现的范围。
研究人群包括109名年龄为13±4.9岁的先证者和412名年龄为28.7±16.2岁的一级亲属。测定了所有先证者以及412名一级亲属中100人的自身免疫性甲状腺炎和乳糜泻的患病率。对照组包括78名年龄为14.9±10.4岁的受试者用于自身免疫性甲状腺炎患病率的研究，以及120000名16 - 17岁的青少年用于乳糜泻患病率的研究。甲状腺炎和乳糜泻通过甲状腺过氧化物酶（TPO）、甲状腺球蛋白（TG）、抗麦胶蛋白和抗肌内膜抗体滴度异常升高来诊断。乳糜泻通过活检确诊。使用问卷对先证者和亲属进行访谈以确定自身免疫表现的范围。
通过高TPO和/或TG滴度确定的先证者和亲属自身免疫性甲状腺炎的患病率分别为27%和25%。这些患病率高于对照组（P < 0.001）。先证者和经筛查的亲属中乳糜泻的患病率分别为8.3%和6%。这些患病率高于对照组以及仅接受访谈的312名家庭成员（分别为0.1%和0.3%；P < 0.0001）。对参与者的访谈揭示了广泛的相关自身免疫性疾病。在先证者有额外自身免疫表现的家庭中，患自身免疫性疾病的风险更高（P < 0.001）。
应对1型糖尿病患者及其一级亲属进行自身免疫性甲状腺炎和乳糜泻的筛查，尤其是当先证者有额外自身免疫表现时。
