大规模人群筛查儿童乳糜泻：1993 年至 2009 年在圣马力诺共和国的经验。

Mass population screening for celiac disease in children: the experience in Republic of San Marino from 1993 to 2009.

机构信息

Department of Pediatrics, Public Hospital of Republic of San Marino, Via Scialoja 40, 47893 San Marino, Repubblica di San Marino.

出版信息

Ital J Pediatr. 2013 Oct 23;39:67. doi: 10.1186/1824-7288-39-67.

DOI:10.1186/1824-7288-39-67

PMID:24152602

原文链接:https://pmc.ncbi.nlm.nih.gov/articles/PMC3875895/

Abstract

BACKGROUND

Prevalence of celiac disease in developed countries is assessed about 1:100-1:150. The real prevalence is unknown because mass screenings are expensive and difficult to organize. Moreover celiac disease can affect people at every age and studies on asymptomatic subjects at different ages are not comparable. In this study we wanted to know the real prevalence of celiac disease in children in the Republic of San Marino. We also analysed concordance of different tests used and costs of mass screening.

METHODS

The study started in 1993. From 1993 to 1997 children aged 6, 10 and 14 were screened. Since 1997 only children aged 6 were monitored, in order to have a homogeneous population. In fact, every child born since 1980 was taken into account. Children were recruited by classroom lists of students for general paediatric examination. Until 2005 the screening test was based on dosage of antibodies anti-gliadin (AGA) IgA and IgG on venous blood. Since 2006 these tests were replaced by anti-transglutaminase IgA antibodies (ATTG). Anti-endomysial antibodies (EMA) were performed if result of any between either AGA or ATTG tests was positive or borderline; if EMA was positive, then an endoscopy with histological examination was performed to confirm the final diagnosis.

RESULTS

Attendance to paediatric examination was 96%, submission to blood test was 87%. 42 on 5092 (0,8%; 1:125) children resulted affected by celiac disease. Histology always confirmed diagnosis by serology except for two cases. AGA test (until 2005) yielded 28 on 4304 (0,7% 1:143); ATTG test (since 2006) revealed 14 positive cases on 788 (1,8%; 1:55) leading to a larger percentage of diagnosis. EMA antibodies always confirmed positivity of ATTG.

CONCLUSIONS

Prevalence of celiac disease in children of Republic of San Marino is comparable to other North-European Countries. Sensitivity of ATTG proved much higher than that of anti-gliadin antibodies. Concordance between ATTG and EMA was 100%. Concordance between serology and histology was approximately 100%. Cost of screening was yearly about 5000 euros (250 children screened every year).

摘要

背景

在发达国家，乳糜泻的患病率约为 1:100-1:150。实际患病率尚不清楚，因为大规模筛查既昂贵又难以组织。此外，乳糜泻可影响各个年龄段的人群，而且对不同年龄段的无症状人群进行的研究也无法进行比较。在这项研究中，我们想了解圣马力诺共和国儿童中乳糜泻的真实患病率。我们还分析了不同检测方法的一致性和大规模筛查的成本。

方法

该研究始于 1993 年。1993 年至 1997 年，对 6 岁、10 岁和 14 岁的儿童进行了筛查。自 1997 年以来，仅对 6 岁的儿童进行了监测，以便获得同质人群。事实上，自 1980 年以来出生的每个儿童都被纳入考虑范围。通过学生班级名单对儿童进行招募，以进行常规儿科检查。直到 2005 年，筛查试验均基于静脉血中抗麦胶蛋白（AGA）IgA 和 IgG 的抗体滴度。自 2006 年以来，这些检测已被抗转谷氨酰胺酶 IgA 抗体（ATTG）取代。如果任何 AGA 或 ATTG 检测结果为阳性或边界值，则进行抗内膜抗体（EMA）检测；如果 EMA 阳性，则进行内镜检查和组织学检查以确认最终诊断。

结果

儿科检查的就诊率为 96%，血液检测的送检率为 87%。在 5092 名儿童中，有 42 名（0.8%；1:125）被确诊患有乳糜泻。除了两例外，组织学检查均始终证实了血清学检查的诊断。AGA 检测（直至 2005 年）在 4304 名儿童中检出 28 例（0.7%；1:143）；ATTG 检测（自 2006 年以来）在 788 名儿童中发现 14 例阳性（1.8%；1:55），从而使诊断率有所提高。EMA 抗体始终确认 ATTG 的阳性。