Barbato M, Viola F, Miglietta M R, Argo G, Iulianella V R, Di Giuseppe S, Pippa G, Gentiloni Silverj F, Lo Russo L, Frediani T, Lucarelli S, Multari G, Cardi E
Department of Pediatrics, University of Rome La Sapienza, Rome.
Minerva Gastroenterol Dietol. 1998 Mar;44(1):1-5.
The association between diabetes mellitus and coeliac disease has been known for many years. In a random group of 175 insulin dependent diabetes mellitus patients of varying ages the following tests have been carried out: serum antigliadin antibodies (AGA) of IgA and IgG class, antireticulin antibodies (ARA) and antiendomisyum antibodies (AEA), both of IgA class.
The patients, 85 males and 90 females, had ages ranging from 1 yr to 30 yrs (102 in paediatric age--mainly between 6 and 14 years--and 73 adults). Patients with pathological values for AEA and/or ARA underwent an intestinal biopsy.
Out of 175 patients studied, 21 had pathological values for AEA with or without pathological values for ARA and AGA, and 2 patients had only pathological values for ARA. 23 patients (21 with pathological values for AEA with or without ARA and AGA, 2 only for ARA ) underwent intestinal biopsy, all patients with pathological values for AEA had villous atrophy. The prevalence of coeliac disease among IDDM patients was 8.8% (95% CI 3.3 to 14.3) for the children and 16.4% (95% CI 7.9 to 24.9) for the adults. In patients with mucous atrophy, ARA, AGA IgA and IgG were pathological in 85%, 71% and 61% respectively. Symptoms and insulin requirements in all patients affected by coeliac disease before and after one year on a gluten free diet were also evaluated. The patients had clinical features with prevalently one or only few atypical symptoms which disappeared on a gluten free diet. Insulin requirements after one year on a gluten free diet appeared unchanged in coeliac patients.
The need to screen all diabetic patients for coeliac disease is underlined.
糖尿病与乳糜泻之间的关联已为人所知多年。在一组随机选取的175名年龄各异的胰岛素依赖型糖尿病患者中，进行了以下检测：IgA和IgG类血清抗麦胶蛋白抗体（AGA）、抗网硬蛋白抗体（ARA）以及IgA类抗内因子抗体（AEA）。
患者共175例，其中男性85例，女性90例，年龄范围为1岁至30岁（儿童102例，主要年龄在6至14岁之间；成人73例）。AEA和/或ARA检测值异常的患者接受了肠道活检。
在研究的175例患者中，21例AEA检测值异常，伴或不伴有ARA和AGA检测值异常；2例仅ARA检测值异常。23例患者（21例AEA检测值异常，伴或不伴有ARA和AGA异常，2例仅ARA异常）接受了肠道活检，所有AEA检测值异常的患者均出现绒毛萎缩。儿童IDDM患者中乳糜泻的患病率为8.8%（95%可信区间3.3至14.3），成人为16.4%（95%可信区间7.9至24.9）。在出现黏膜萎缩的患者中，ARA、AGA IgA和IgG检测值异常的比例分别为85%、71%和61%。还评估了所有乳糜泻患者在无麸质饮食一年前后的症状和胰岛素需求量。这些患者的临床特征主要为一种或仅有少数非典型症状，在无麸质饮食后消失。乳糜泻患者在无麸质饮食一年后的胰岛素需求量似乎未发生变化。
强调了对所有糖尿病患者进行乳糜泻筛查的必要性。
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