Virta Lauri J, Kaukinen Katri, Collin Pekka
Social Insurance Institution, Research Department, Turku, Finland.
Scand J Gastroenterol. 2009;44(8):933-8. doi: 10.1080/00365520903030795.
The majority of patients with coeliac disease remain undetected world-wide. Finland has aimed at a high detection rate by training health personnel, and has advocated serologic screening for known coeliac disease risk groups. The purpose here was to assess whether this approach has been effective in clinical practice.
The study was based on a prospective database of new coeliac patients aged 16 years or more, to whom the Social Insurance Institution had paid monthly compensation for the additional cost of maintaining a gluten-free diet since 2002. To obtain this compensation the diagnostic criteria for coeliac disease, including biopsy findings, had to be attested in a statement from a physician. The incidence and prevalence rates were calculated until the end of 2006. The total population aged 16 years or more was 4.31 million.
In 2004-06, a total of 5020 persons (64% female) receiving a new dietary grant were identified through the database. The mean annual incidence of proven coeliac disease was thus 39 per 100,000 individuals. Altogether, 23,553 persons received the dietary grant. This gives a nation-wide point prevalence of adult coeliac disease of 0.55% (0.70% F, 0.38% M). There was a regional variation from 33 to 49 per 100,000 in the annual incidence and from 0.41% to 0.72% in the prevalence of coeliac disease.
To the best of our knowledge, these figures for proven coeliac disease are the highest reported. Increased alertness to the condition and active case finding has made this efficient diagnostics possible.
在全球范围内,大多数乳糜泻患者仍未被诊断出来。芬兰致力于通过培训卫生人员来提高诊断率,并提倡对已知的乳糜泻风险群体进行血清学筛查。本文旨在评估这种方法在临床实践中是否有效。
本研究基于一个前瞻性数据库,该数据库收录了16岁及以上的新确诊乳糜泻患者,自2002年以来,社会保险机构每月为这些患者支付维持无麸质饮食的额外费用。为获得这笔补偿,乳糜泻的诊断标准,包括活检结果,必须由医生出具证明。计算截至2006年底的发病率和患病率。16岁及以上的总人口为431万。
在2004 - 2006年期间,通过该数据库共识别出5020人(64%为女性)获得了新的饮食补助。因此,确诊乳糜泻的平均年发病率为每10万人中有39人。共有23553人获得了饮食补助。这使得全国成人乳糜泻的点患病率为0.55%(女性为0.70%,男性为0.38%)。乳糜泻的年发病率在每10万人中从33例到49例不等,患病率在0.41%到0.72%之间存在地区差异。
据我们所知,这些确诊乳糜泻的数据是报告中最高的。对该病的更高警惕性和积极的病例发现使得这种高效的诊断成为可能。