Pall Harpreet, Newhook Leigh A, Aaron Hillary, Curtis Joseph, Randell Ed
Department of Pediatrics, Drexel University College of Medicine and St. Christopher's Hospital for Children, Philadelphia, PA, 19130, USA.
Janeway Pediatric Research Unit, Faculty of Medicine, Memorial University of Newfoundland, St. John's, NL, Canada, A1B 3V6.
Children (Basel). 2015 Oct 14;2(4):403-11. doi: 10.3390/children2040403.
The objectives of this study were to establish the prevalence of positive antibodies to endomysium (EMA) and tissue transglutaminase (tTG) in children with type 1 diabetes living in Newfoundland and Labrador (NL), and to examine clinical features associated with positive antibodies.
Patients were recruited from the pediatric diabetes clinic. One hundred sixty-seven children with type 1 diabetes from the 280 children followed at the clinic were prospectively screened for celiac disease using EMA and tTG. The variables of Irish descent, age at onset of diabetes, duration of diabetes, sex, family history of celiac disease, hemoglobin A1C (A1C), ferritin, gastrointestinal symptoms, and body mass index were compiled for all patients. The group of patients with positive antibodies to EMA and/or tTG was compared to the group with negative antibodies.
The prevalence of patients with positive antibodies to EMA and/or tTG was 16.8% (n = 28). One patient had also been previously diagnosed with symptomatic celiac disease. The two statistically significant variables with positive antibodies were an earlier age at onset of diabetes (Mann-Whitney U two-tailed test: mean difference 3.2 years, 95% CI 1.7-4.8 years, p < 0.0001) and longer duration of diabetes (Mann-Whitney U two-tailed test: mean difference 2.9 years, 95% CI 1.3-4.4 years, p < 0.0001). Irish descent was associated with positive antibodies but did not reach statistical significance. On logistic regression analysis performed with these three variables together, only age at onset of diabetes remained significant.
There is a high prevalence of celiac disease-associated antibodies in children living in NL with type 1 diabetes. Unlike other clinical features, an earlier age at onset of diabetes was predictive for positive antibodies. As the majority of children with positive antibodies did not have signs or symptoms of celiac disease, routine screening for celiac disease in type 1 diabetes is recommended.
本研究的目的是确定居住在纽芬兰和拉布拉多省（NL）的1型糖尿病儿童中抗肌内膜（EMA）抗体和组织转谷氨酰胺酶（tTG）抗体阳性的患病率，并检查与抗体阳性相关的临床特征。
从儿科糖尿病诊所招募患者。对诊所随访的280名儿童中的167名1型糖尿病儿童使用EMA和tTG进行乳糜泻的前瞻性筛查。收集了所有患者的爱尔兰血统、糖尿病发病年龄、糖尿病病程、性别、乳糜泻家族史、糖化血红蛋白（A1C）、铁蛋白、胃肠道症状和体重指数等变量。将EMA和/或tTG抗体阳性的患者组与抗体阴性的患者组进行比较。
EMA和/或tTG抗体阳性患者的患病率为16.8%（n = 28）。一名患者先前也被诊断为有症状的乳糜泻。抗体阳性的两个具有统计学意义的变量是糖尿病发病年龄较早（曼-惠特尼U双尾检验：平均差异3.2岁，95%可信区间1.7 - 4.8岁，p < 0.0001）和糖尿病病程较长（曼-惠特尼U双尾检验：平均差异2.9岁，95%可信区间1.3 - 4.4岁，p < 0.0001）。爱尔兰血统与抗体阳性相关，但未达到统计学意义。对这三个变量一起进行逻辑回归分析时，只有糖尿病发病年龄仍然具有显著性。
居住在NL的1型糖尿病儿童中，与乳糜泻相关的抗体患病率很高。与其他临床特征不同，糖尿病发病年龄较早可预测抗体阳性。由于大多数抗体阳性的儿童没有乳糜泻的体征或症状，建议对1型糖尿病患者进行乳糜泻的常规筛查。
