Warncke Katharina, Liptay Susanne, Fröhlich-Reiterer Elke, Scheuing Nicole, Schebek Martin, Wolf Johannes, Rohrer Tilman R, Meissner Thomas, Holl Reinhard W
Department of Pediatrics, Klinikum rechts der Isar, Technische Universität München, München, Germany.
Institute of Diabetes Research, Helmholtz Zentrum München, and Forschergruppe Diabetes, Klinikum rechts der Isar, Technische Universität München, Neuherberg, Germany.
Pediatr Diabetes. 2016 May;17(3):191-8. doi: 10.1111/pedi.12261. Epub 2015 Feb 12.
Celiac disease (CD) is a common comorbidity of type 1 diabetes (T1D). Long-term consequences of CD are not completely understood, and adhering to a gluten-free diet is a burden for many patients. We investigated the effect of CD on vascular risk factors in a large cohort of T1D patients aged <20 yr.
Within the longitudinal Diabetes Patienten Verlaufsdokumentation (DPV)-diabetes registry, data were analyzed from 59,909 < 20-yr-old T1D patients treated at 392 centers in Germany and Austria. A total of 974 patients with biopsy-proven celiac disease (BPCD) were compared with 28,398 patients without CD with respect to blood pressure (BP), lipids, glycohemoglobin (HbA1c ), body mass index (BMI), and reported smoking behavior.
Patients with T1D and BPCD showed significantly lower high-density lipoprotein (HDL) cholesterol levels [median (interquartile range): 53.0 (43.0-62.6) mg/dL] than patients without CD [55.0 (45.0-66.0) mg/dL; p < 0.01; p < 0.001 after adjustment for confounding variables]. Systolic BP was lower in patients with CD [105.5 (100.0-112.5) mmHg] than in patients without CD [110.0 (102.0-117.0) mmHg; p < 0.0001; p < 0.001 after adjustment]. There were no significant differences regarding smoking behavior, BMI, or HbA1c . In a subgroup of 335 patients with BPCD, HDL cholesterol was measured 1 yr after diagnosis of CD:HDL increased by 8% (p < 0.01).
Young people with T1D and CD have lower HDL cholesterol values than patients without CD. As low HDL cholesterol is associated with vascular risk, our findings support screening for CD and monitoring of HDL cholesterol in young people with T1D.
乳糜泻（CD）是1型糖尿病（T1D）常见的合并症。CD的长期后果尚未完全明了，对许多患者而言，坚持无麸质饮食是一项负担。我们在一个年龄小于20岁的T1D患者大群体中研究了CD对血管危险因素的影响。
在纵向的糖尿病患者病程记录（DPV）糖尿病登记处，分析了德国和奥地利392个中心治疗的59909例年龄小于20岁的T1D患者的数据。将974例经活检证实为乳糜泻（BPCD）的患者与28398例无CD的患者在血压（BP）、血脂、糖化血红蛋白（HbA1c）、体重指数（BMI）及报告的吸烟行为方面进行比较。
T1D和BPCD患者的高密度脂蛋白（HDL）胆固醇水平[中位数（四分位间距）：53.0（43.0 - 62.6）mg/dL]显著低于无CD的患者[55.0（45.0 - 66.0）mg/dL；P<0.01；校正混杂变量后P<0.001]。CD患者的收缩压[105.5（100.0 - 112.5）mmHg]低于无CD的患者[110.0（102.0 - 117.0）mmHg；P<0.0001；校正后P<0.001]。在吸烟行为、BMI或HbA1c方面无显著差异。在335例BPCD患者亚组中，在CD诊断后1年测量HDL胆固醇：HDL升高了8%（P<0.01）。
患有T1D和CD的年轻人的HDL胆固醇值低于无CD的患者。由于低HDL胆固醇与血管风险相关，我们的研究结果支持对T1D青少年进行CD筛查及监测HDL胆固醇。
