Pham-Short Anna, Donaghue Kim C, Ambler Geoffrey, Phelan Helen, Twigg Stephen, Craig Maria E
Institute of Endocrinology and Diabetes, The Children's Hospital at Westmead, Sydney, Australia; Discipline of Pediatrics and Child Health, University of Sydney, Sydney, Australia;
John Hunter Hospital, Newcastle, Australia;
Pediatrics. 2015 Jul;136(1):e170-6. doi: 10.1542/peds.2014-2883. Epub 2015 Jun 15.
Prevalence rates of type 1 diabetes (T1D) and celiac disease (CD) vary from 1.6% to 16.4% worldwide. Screening guidelines are variable and not evidence based. Our aim was to conduct a systematic review of CD in T1D.
Medline, Embase, and the Cochrane Library were searched. Studies were limited to those in English and in humans. We selected longitudinal cohort studies screening for CD in T1D with at least 5 years of follow-up. Screening rates, characteristics, and prevalence of biopsy-proven CD in people with T1D were extracted.
We identified 457 nonduplicate citations; 48 were selected for full-text review. Nine longitudinal cohort studies in 11,157 children and adolescents with 587 cases of biopsy-proven CD met the inclusion criteria. Median follow-up was 10 years (range: 5-18 years). The weighted pooled prevalence of CD was 5.1% (95% confidence interval: 3.1-7.4%). After excluding 41 cases with CD onset before T1D, CD was diagnosed in 218 of 546 (40%) subjects within 1 year, in 55% within 2 years, and in 79% within 5 years of diabetes duration. Two studies (478 cases) reported higher rates of CD in children aged <5 years at T1D diagnosis. The duration of follow-up varied across the included studies. CD screening frequency progressively decreased with increased T1D duration.
Because most cases of CD are diagnosed within 5 years of T1D diagnosis, screening should be considered at T1D diagnosis and within 2 and 5 years thereafter. CD screening should be considered at other times in patients with symptoms suggestive of CD. More research is required to determine the screening frequency beyond 5 years of diabetes duration.
1型糖尿病（T1D）和乳糜泻（CD）的患病率在全球范围内从1.6%到16.4%不等。筛查指南各不相同且缺乏循证依据。我们的目的是对T1D患者中的CD进行系统评价。
检索了Medline、Embase和Cochrane图书馆。研究仅限于英文且以人为研究对象的研究。我们选择了对T1D患者进行CD筛查且随访至少5年的纵向队列研究。提取了T1D患者中活检证实的CD的筛查率、特征和患病率。
我们识别出457条非重复引文；48条被选作全文综述。11157名儿童和青少年中进行的9项纵向队列研究，其中587例活检证实的CD符合纳入标准。中位随访时间为10年（范围：5 - 18年）。CD的加权合并患病率为5.1%（95%置信区间：3.1 - 7.4%）。排除41例在T1D之前发病的CD病例后，546名受试者中有218例（40%）在糖尿病病程1年内被诊断为CD，55%在2年内，79%在5年内。两项研究（478例）报告T1D诊断时年龄<5岁的儿童CD发病率更高。纳入研究的随访时间各不相同。CD筛查频率随T1D病程延长而逐渐降低。
由于大多数CD病例在T1D诊断后5年内被诊断出来，应在T1D诊断时以及此后2年和5年内考虑进行筛查。有CD症状提示的患者在其他时间也应考虑进行CD筛查。需要更多研究来确定糖尿病病程超过5年后的筛查频率。
