Sharifi Nasrin, Khoshbaten Manouchehr, Aliasgarzade Akbar, Bahrami Amir
Int J Diabetes Dev Ctries. 2008 Jul;28(3):95-9. doi: 10.4103/0973-3930.44081.
High prevalence rates of celiac disease (CD) in patients with type-1 diabetes mellitus (T1DM) have been reported in several countries. However, the data regarding this association are scarce in Iran. In this study, we report the prevalence of CD in patients with T1DM in northwest of Iran using tissue transglutaminase antibodies (tTGA) as a screening test.
One hundred patients with T1DM (58 women and 42 men) aged 21.8 +/- 8.86 years (age range: 7-50 years) were compared with 150 healthy people (82 women and 68 men) aged 28.9 +/- 9.07 years (age range: 4-50 years). All subjects were serologically screened for the presence of tTGA. Total immunoglobin A (IgA) was obtained to investigate IgA deficiency. Subjects positive for tTGA and deficient for IgA were submitted to upper gastrointestinal endoscopy.
Eight patients with T1DM (8%) and three of the controls (2%) were positive for tTGA (P = 0.023), while only 3% of the tTGA positive T1DM patients underwent duodenal biopsy and all of them showed partial or total villous atrophy. The mean age of tTGA positive cases was significantly lower than tTGA negative ones (mean difference 7.17; 95% CI: 0.82-13.52). None of the tTGA positive T1DM patients had a history of chronic diarrhea, but one out of eight tTGA positives reported history of dermatitis (P = 0.001). Also, none of the tTGA positive subjects presented IgA deficiency. There was a significant difference in history of chronic diarrhea (P = 0.006) and autoimmune diseases (P = 0.001) between patients with T1DM and controls.
This study showed higher prevalence of CD in patients with T1DM than in general population of northwest Iran and the data lend support to recommend regular screening for CD in all patients with T1DM.
在一些国家，1型糖尿病（T1DM）患者中乳糜泻（CD）的患病率较高。然而，在伊朗，关于这种关联的数据很少。在本研究中，我们使用组织转谷氨酰胺酶抗体（tTGA）作为筛查试验，报告伊朗西北部T1DM患者中CD的患病率。
将100例年龄为21.8±8.86岁（年龄范围：7 - 50岁）的T1DM患者（58名女性和42名男性）与150名年龄为28.9±9.07岁（年龄范围：4 - 50岁）的健康人（82名女性和68名男性）进行比较。所有受试者均进行tTGA血清学筛查。检测总免疫球蛋白A（IgA）以调查IgA缺乏情况。tTGA阳性且IgA缺乏的受试者接受上消化道内镜检查。
8例T1DM患者（8%）和3例对照者（2%）tTGA呈阳性（P = 0.023），而tTGA阳性的T1DM患者中只有3%接受了十二指肠活检，且所有活检结果均显示部分或完全绒毛萎缩。tTGA阳性病例的平均年龄显著低于tTGA阴性病例（平均差异7.17；95%置信区间：0.82 - 13.52）。tTGA阳性的T1DM患者均无慢性腹泻病史，但8例tTGA阳性者中有1例报告有皮炎病史（P = 0.001）。此外，tTGA阳性受试者均无IgA缺乏。T1DM患者与对照者在慢性腹泻病史（P = 0.006）和自身免疫性疾病（P = 0.001）方面存在显著差异。
本研究表明，T1DM患者中CD的患病率高于伊朗西北部的普通人群，这些数据支持对所有T1DM患者进行CD定期筛查的建议。
