Hansen Dorte, Brock-Jacobsen Bendt, Lund Elisabeth, Bjørn Christina, Hansen Lars P, Nielsen Christian, Fenger Claus, Lillevang Søren T, Husby Steffen
Department of Pediatrics, Odense University Hospital, Sdr. Boulevard 29, 5000 Odense C, Denmark.
Diabetes Care. 2006 Nov;29(11):2452-6. doi: 10.2337/dc06-0990.
This study was performed to 1) determine the prevalence of celiac disease in Danish children with type 1 diabetes and 2) estimate the clinical effects of a gluten-free diet (GFD) in patients with diabetes and celiac disease.
In a region comprising 24% of the Danish population, all patients <16 years old with type 1 diabetes were identified and 269 (89%) were included in the study. The diagnosis of celiac disease was suspected in patients with endomysium and tissue transglutaminase antibodies in serum and confirmed by intestinal biopsy. Patients with celiac disease were followed for 2 years while consuming a GFD.
In 28 of 33 patients with celiac antibodies, an intestinal biopsy showed villous atrophy. In 5 patients, celiac disease had been diagnosed previously, giving an overall prevalence of 12.3% (95% CI 8.6-16.9). Patients with celiac disease had a lower SD score (SDS) for height (P < 0.001) and weight (P = 0.002) than patients without celiac disease and were significantly younger at diabetes onset (P = 0.041). A GFD was obtained in 31 of 33 patients. After 2 years of follow-up, there was an increase in weight SDS (P = 0.006) and in children <14 years old an increase in height SDS (P = 0.036). An increase in hemoglobin (P = 0.002) and serum ferritin (P = 0.020) was found, whereas HbA(1c) remained unchanged (P = 0.311) during follow-up.
This population-based study showed the highest reported prevalence of celiac disease in type 1 diabetes in Europe. Patients with celiac disease showed clinical improvements with a GFD. We recommend screening for celiac disease in all children with type 1 diabetes.
本研究旨在1）确定丹麦1型糖尿病儿童中乳糜泻的患病率，以及2）评估无麸质饮食（GFD）对糖尿病合并乳糜泻患者的临床疗效。
在丹麦24%人口的区域内，识别出所有16岁以下的1型糖尿病患者，其中269例（89%）纳入研究。血清中存在肌内膜和组织转谷氨酰胺酶抗体的患者被怀疑患有乳糜泻，并通过肠道活检确诊。患有乳糜泻的患者在食用GFD的同时接受了2年的随访。
33例乳糜泻抗体阳性患者中，28例肠道活检显示绒毛萎缩。5例患者之前已被诊断为乳糜泻，总体患病率为12.3%（95%可信区间为8.6 - 16.9）。与无乳糜泻的患者相比，患有乳糜泻的患者身高标准差评分（SDS）较低（P < 0.001），体重标准差评分（P = 0.002）较低，且糖尿病发病时年龄显著更小（P = 0.041）。33例患者中有31例采用了GFD。随访2年后，体重SDS增加（P = 0.006），14岁以下儿童身高SDS增加（P = 0.036）。随访期间发现血红蛋白增加（P = 0.002）和血清铁蛋白增加（P = 0.020），而糖化血红蛋白（HbA1c）保持不变（P = 0.311）。
这项基于人群的研究显示，欧洲1型糖尿病患者中乳糜泻的患病率是报道中最高的。患有乳糜泻的患者采用GFD后临床症状有所改善。我们建议对所有1型糖尿病儿童进行乳糜泻筛查。
