Myśliwiec Małgorzata, Balcerska Anna, Stepiński Jan, Bakowska Alicja, Jedrzejczyk Anna, Bautembach-Minkowska Joanna, Sztangierska Beata, Banach Piotr, Wiśniewski Piotr
Klinika Pediatrii, Hematologii, Onkologii i Endokrynologii AM w Gdańsku, Gdańsk.
Endokrynol Diabetol Chor Przemiany Materii Wieku Rozw. 2006;12(4):281-5.
Discussion on the frequency of coexistent celiac disease and type 1 diabetes mellitus (DM1) as well as an attempt to standardize diagnostic methods of celiac disease detection among DM1 children have been performed.
To assess the incidence of celiac disease among DM1 children in the Pomeranian region of Poland followed by analysis of the putative prognostic factors for celiac disease development in this particular group of children.
70 children aged 9.47+/-4.59 (group 1) de novo diagnosed with DM1 and 223 children aged 10.20+/-3.87 with long-standing diabetes mellitus type 1 (4.47+/-3.16 years from the diagnosis) were enrolled in the study. All the patients had C-peptide, HbA1c, CRP, TSH, fT4, fT3, urinary albumin secretion rate, IgA, level of antigliadin antibodies (AGA), anti-tissue transglutaminase (TGA) IgA and IgG antibodies (ELISA), anti-endomysium (EmA) IgA and IgG antibodies (immunofluorescence) and anti-tyreoglobulin antibodies (TG), anti-thyroid peroxidase (TPO) antibodies (ELISA) evaluated. All the patients had jejunal biopsy and thyroid ultrasound examination.
5.7% of group 1 patients were diagnosed with celiac disease based on the positive jejunal biopsy in comparison with 9.4% in the group 2. TGA antibodies were present in 9.52% of group 2, AGA in 7.62%, EmA in 6.19%. 10% of group 1 children had autoimmune thyroiditis versus 24.2% of group 2 children. The group of children with coincident long-lasting DM1 and celiac disease (group A) was characterized by significantly earlier age at diagnosis (p=0.003), higher HbA(1)c (p=<0.001), CRP (p<0.001) and elevated urine albumin secretion in relation to children without celiac disease and autoimmune thyroiditis (group B). Serologic test detecting TGA antibodies was found to be the most sensitive (95.2%) for the detection of celiac disease among DM1 children, while the lowest sensitivity was obtained in the case of the EmA antibody test (61.9%).
The celiac disease morbidity confirmed by jejunal biopsy is high among DM1 children (9.4%). The assessment of the serum TGA appears to be the most sensitive screening marker for the celiac disease detection in DM1 children.
已对乳糜泻与1型糖尿病（DM1）共存的频率进行了讨论，并尝试规范DM1儿童乳糜泻检测的诊断方法。
评估波兰波美拉尼亚地区DM1儿童中乳糜泻的发病率，随后分析该特定儿童群体中乳糜泻发生的假定预后因素。
70名初诊为DM1的9.47±4.59岁儿童（第1组）和223名患有长期1型糖尿病（诊断后4.47±3.16年）的10.20±3.87岁儿童纳入研究。所有患者均检测了C肽、糖化血红蛋白（HbA1c）、C反应蛋白（CRP）、促甲状腺激素（TSH）、游离甲状腺素（fT4）、游离三碘甲状腺原氨酸（fT3）、尿白蛋白分泌率、免疫球蛋白A（IgA）、抗麦醇溶蛋白抗体（AGA）水平、抗组织转谷氨酰胺酶（TGA）IgA和IgG抗体（酶联免疫吸附测定法）、抗肌内膜（EmA）IgA和IgG抗体（免疫荧光法）以及抗甲状腺球蛋白抗体（TG）、抗甲状腺过氧化物酶（TPO）抗体（酶联免疫吸附测定法）。所有患者均进行了空肠活检和甲状腺超声检查。
第1组中5.7%的患者经空肠活检阳性被诊断为乳糜泻，而第2组为9.4%。第2组中9.52%的患者存在TGA抗体，7.62%存在AGA，6.19%存在EmA。第1组10%的儿童患有自身免疫性甲状腺炎，而第2组儿童为24.2%。患有长期DM1和乳糜泻的儿童组（A组）与无乳糜泻和自身免疫性甲状腺炎的儿童（B组）相比，其诊断时年龄显著更小（p = 0.003），HbA1c更高（p = <0.001），CRP更高（p <0.001）且尿白蛋白分泌升高。发现检测TGA抗体的血清学检测对DM1儿童乳糜泻的检测最敏感（95.2%），而EmA抗体检测的敏感性最低（61.9%）。
经空肠活检证实，DM1儿童中乳糜泻发病率较高（9.4%）。血清TGA评估似乎是DM1儿童乳糜泻检测中最敏感的筛查标志物。
