Ludvigsson Jonas F, Ludvigsson Johnny, Ekbom Anders, Montgomery Scott M
Department of Pediatrics, Orebro University Hospital, Orebro 701 85, Sweden.
Diabetes Care. 2006 Nov;29(11):2483-8. doi: 10.2337/dc06-0794.
Earlier studies suggest that children with type 1 diabetes are more likely to have a subsequent diagnosis of celiac disease. However, research is sparse on the risk of subsequent type 1 diabetes in individuals with celiac disease. We sought to determine the risk of subsequent type 1 diabetes diagnosed before the age of 20 years in children and adolescents with celiac disease in a national, general population-based cohort.
We identified 9,243 children with a diagnosis of celiac disease in the Swedish national inpatient register between 1964 and 2003. We then identified five reference individuals matched at time of diagnosis for age, calendar year, sex, and county (n = 45,680). Only individuals with >1 year of follow-up after study entry (diagnosis of celiac disease) were included in the analyses.
Celiac disease was associated with a statistically significantly increased risk of subsequent type 1 diabetes before age 20 years (hazard ratio 2.4 [95% CI 1.9-3.0], P < 0.001). This risk increase was seen regardless of whether celiac disease was first diagnosed between 0 and 2 (2.2 [1.7-2.9], P < 0.001) or 3 and 20 (3.4 [1.9-6.1], P < 0.001) years of age. Individuals with prior celiac disease were also at increased risk of ketoacidosis or diabetic coma before the age of 20 years (2.3 [1.4-3.9], P = 0.001).
Children with celiac disease are at increased risk of subsequent type 1 diabetes. This risk increase is low considering that 95% of individuals with celiac disease are HLA-DQ2 positive.
早期研究表明，1型糖尿病患儿更有可能随后被诊断为乳糜泻。然而，关于乳糜泻患者随后患1型糖尿病的风险的研究较少。我们试图在一个全国性的、基于普通人群的队列中，确定患有乳糜泻的儿童和青少年在20岁之前被诊断为后续1型糖尿病的风险。
我们在瑞典国家住院登记处中识别出1964年至2003年间被诊断为乳糜泻的9243名儿童。然后我们确定了五名在诊断时年龄、历年、性别和郡县相匹配的对照个体（n = 45680）。分析仅纳入研究入组（乳糜泻诊断）后有超过1年随访的个体。
乳糜泻与20岁之前后续发生1型糖尿病的风险在统计学上显著增加相关（风险比2.4 [95%可信区间1.9 - 3.0]，P < 0.001）。无论乳糜泻最初是在0至2岁（2.2 [1.7 - 2.9]，P < 0.001）还是3至20岁（3.4 [1.9 - 6.1]，P < 0.001）被诊断，这种风险增加都可见。既往有乳糜泻的个体在20岁之前发生酮症酸中毒或糖尿病昏迷的风险也增加（2.3 [1.4 - 3.9]，P = 0.001）。
患有乳糜泻的儿童后续患1型糖尿病的风险增加。考虑到95%的乳糜泻患者HLA - DQ2呈阳性，这种风险增加幅度较低。
