Institute of Endocrinology and Diabetes, The Children's Hospital at Westmead, NSW, Australia.
Diabet Med. 2012 Sep;29(9):e286-9. doi: 10.1111/j.1464-5491.2012.03720.x.
To determine the incidence of coeliac disease in young people with Type 1 diabetes and to examine the effect of age at diabetes onset and disease duration.
This was a clinic-based observational cohort study of 4379 people aged ≤ 18 years (49% male) between 1990 and 2009 from Sydney, Australia. Screening for coeliac disease was performed at diagnosis and 1-2 yearly using anti-endomysial and/or anti-tissue transglutaminase immunoglobulin A (IgA) antibodies. Coeliac disease was diagnosed by small bowel biopsy based on Marsh score ≥ III.
Coeliac disease was confirmed by biopsy in 185; of these, 61 (33%) were endomysial or tissue transglutaminase IgA antibody-positive at diabetes diagnosis. Mean age at diabetes onset was 6.6 ± 4.0 vs. 8.4 ± 4.1 years in those without coeliac disease (P < 0.001). Mean incidence was 7.7 per 1000 person years (95% CI 6.6-8.9) over 20 years. Incidence was higher in children aged < 5 years at diabetes diagnosis (10.4 per 1000 person years) vs. ≥ 5 years (6.4 per 1000), incidence rate ratio 1.6 (95% CI 1.2-2.2, P = 0.002). Coeliac disease was diagnosed after 2, 5 and 10 years of diabetes in 45, 78 and 94% of cases, respectively. Median time to coeliac disease diagnosis was longer in children aged < 5 years at diabetes onset (3.3 years) compared with older children (0.7 years, P < 0.001).
Coeliac disease is common in young people with Type 1 diabetes; the risk is greatest with diabetes onset < 5 years, but after longer diabetes duration. Screening for coeliac disease should be performed at diabetes diagnosis and for at least 10 years in young children.
确定青少年 1 型糖尿病患者中乳糜泻的发病率，并探讨发病年龄和疾病持续时间的影响。
这是一项基于诊所的观察性队列研究，纳入了 1990 年至 2009 年期间来自澳大利亚悉尼的 4379 名年龄≤18 岁（49%为男性）的人群。在诊断时和每年 1-2 次使用抗内膜肌抗体和/或抗组织转谷氨酰胺酶免疫球蛋白 A（IgA）抗体进行乳糜泻筛查。基于 Marsh 评分≥III 级的小肠活检诊断乳糜泻。
活检证实乳糜泻 185 例，其中 61 例（33%）在糖尿病诊断时抗内膜肌或组织转谷氨酰胺酶 IgA 抗体阳性。糖尿病发病年龄分别为（6.6±4.0）岁和（8.4±4.1）岁，无乳糜泻者年龄更小（P<0.001）。20 年间的平均发病率为每 1000 人年 7.7 例（95%CI 6.6-8.9）。发病年龄较小的儿童（糖尿病诊断时<5 岁）发病率更高（每 1000 人年 10.4 例），5 岁以上者发病率较低（每 1000 人年 6.4 例），发病率比为 1.6（95%CI 1.2-2.2，P=0.002）。乳糜泻分别在糖尿病发病后 2、5 和 10 年诊断，分别占病例的 45%、78%和 94%。发病年龄较小的儿童（<5 岁）乳糜泻的中位诊断时间（3.3 年）长于较大儿童（0.7 年，P<0.001）。
青少年 1 型糖尿病患者中乳糜泻很常见；发病年龄<5 岁时风险最大，但随着糖尿病持续时间的延长，风险也会增加。应在糖尿病诊断时和儿童时期至少 10 年内进行乳糜泻筛查。
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