Ji Jianguang, Ludvigsson Jonas F, Sundquist Kristina, Sundquist Jan, Hemminki Kari
Center for Primary Health Care Research, Lund University, Sweden.
Scand J Gastroenterol. 2011 Jul;46(7-8):844-8. doi: 10.3109/00365521.2011.579999. Epub 2011 May 2.
The incidence of celiac disease (CD) shows large, worldwide variation. However, whether its causes are environmental (gluten-containing diet) or genetic (specific haplotype) have not been established. The aim of the present study is to examine the incidence of CD among second-generation immigrants and adoptees from abroad to disentangle genetic/ethnic versus environmental influences (assuming that immigrants have similar gluten exposures to native Swedes, and thus differ from them only in terms of their genetic background).
Second-generation immigrants and adoptees from abroad were identified in the MigMed 2 Database and were followed until diagnosis of CD, death, or the end of study. Standardized incidence ratios (SIRs) were calculated among these immigrants with native Swedes as the reference group.
A total of 1,050,569 children were defined as second-generation immigrants and the overall SIR of CD (SIR = 0.89, 95% confidence interval 0.84-0.94) was significantly lower than that of native Swedes. The incidence of CD among children with parents from Western, Eastern, and Northern European countries was similar to that in native Swedes, but was lower for those with parents from low-prevalence countries, especially Eastern and Southeast Asian countries. A total of 51,557 children born in foreign countries were adopted by Swedes. Adoptees from Eastern Asia had a significantly decreased SIR of CD.
The decreased incidence of CD in second-generation immigrants and some groups of adoptees from abroad strongly suggests that ethnic genetic heterogeneity may contribute to the worldwide variation in CD incidence.
乳糜泻（CD）的发病率在全球范围内存在很大差异。然而，其病因是环境因素（含麸质饮食）还是遗传因素（特定单倍型）尚未明确。本研究的目的是调查第二代移民和国外领养儿童中CD的发病率，以厘清遗传/种族与环境因素的影响（假设移民与瑞典本地人有相似的麸质暴露情况，因此他们之间的差异仅在于遗传背景）。
在MigMed 2数据库中识别出第二代移民和国外领养儿童，并对其进行随访，直至诊断出CD、死亡或研究结束。以瑞典本地人为参照组，计算这些移民中的标准化发病率（SIR）。
共有1,050,569名儿童被定义为第二代移民，CD的总体SIR（SIR = 0.89，95%置信区间0.84 - 0.94）显著低于瑞典本地人。父母来自西欧、东欧和北欧国家的儿童中CD的发病率与瑞典本地人相似，但父母来自低发病率国家（尤其是东亚和东南亚国家）的儿童发病率较低。共有51,557名在国外出生的儿童被瑞典人领养。来自东亚的领养儿童CD的SIR显著降低。
第二代移民和一些国外领养儿童群体中CD发病率的降低强烈表明，种族遗传异质性可能是导致全球CD发病率差异的原因。
