Isaac Daniela Migliarese, Rajani Seema, Yaskina Maryna, Huynh Hien Q, Turner Justine M
*Department of Pediatric Gastroenterology and Nutrition †Department of Pediatrics, Faculty of Medicine and Dentistry ‡Women and Children's Health Research Institute, University of Alberta, Edmonton, AB, Canada.
J Pediatr Gastroenterol Nutr. 2017 Aug;65(2):195-199. doi: 10.1097/MPG.0000000000001480.
Limited pediatric data exist examining the trend and predictors of antitissue transglutaminase (atTG) normalization over time in children with celiac disease (CD). We aimed to evaluate time to normalization of atTG in children after CD diagnosis, and to assess for independent predictors affecting this duration.
A retrospective chart review was completed in pediatric patients with CD diagnosed from 2007 to 2014 at the Stollery Children's Hospital Celiac Clinic (Edmonton, Alberta, Canada). The clinical predictors assessed for impact on time to atTG normalization were initial atTG, Marsh score at diagnosis, gluten-free diet compliance (GFDC), age at diagnosis, sex, ethnicity, medical comorbidities, and family history of CD. Kaplan-Meier survival analysis was completed to assess time to atTG normalization, and Cox regression to assess for independent predictors of this time.
A total of 487 patients met inclusion criteria. Approximately 80.5% of patients normalized atTG levels. Median normalization time was 407 days for all patients (95% confidence interval [CI: 361-453]), and 364 days for gluten-free diet compliant patients (95% CI [335-393]). Type 1 diabetes mellitus (T1DM) patients took significantly longer to normalize at 1204 days (95% CI [199-2209], P < 0.001). Cox regression demonstrated T1DM (hazard ratio = 0.36 [0.24-0.55], P < 0.001) and higher baseline atTG (hazard ratio = 0.52 [0.43-0.63], P < 0.001) were significant predictors of longer atTG normalization time. GFDC was a significant predictor of earlier normalization (OR = 13.91 [7.86-24.62], P < 0.001).
GFDC and lower atTG at diagnosis are predictors of earlier normalization. Patients with T1DM are less likely to normalize atTG levels, with longer normalization time. Additional research and education for higher-risk populations are needed.
关于乳糜泻（CD）患儿抗组织转谷氨酰胺酶（atTG）随时间恢复正常的趋势和预测因素的儿科数据有限。我们旨在评估CD诊断后患儿atTG恢复正常的时间，并评估影响这一持续时间的独立预测因素。
对2007年至2014年在加拿大艾伯塔省埃德蒙顿市斯托里儿童医院乳糜泻诊所确诊的儿科CD患者进行回顾性病历审查。评估对atTG恢复正常时间有影响的临床预测因素包括初始atTG、诊断时的马什评分、无麸质饮食依从性（GFDC）、诊断时的年龄、性别、种族、合并症以及CD家族史。采用Kaplan-Meier生存分析评估atTG恢复正常的时间，并采用Cox回归评估该时间的独立预测因素。
共有487例患者符合纳入标准。约80.5%的患者atTG水平恢复正常。所有患者atTG恢复正常的中位时间为407天（95%置信区间[CI：361 - 453]），无麸质饮食依从的患者为364天（95%CI[335 - 393]）。1型糖尿病（T1DM）患者恢复正常的时间明显更长，为1204天（95%CI[199 - 2209]，P<0.001）。Cox回归显示，T1DM（风险比 = 0.36[0.24 - 0.55]，P<0.001）和更高的基线atTG（风险比 = 0.52[0.43 - 0.63]，P<0.001）是atTG恢复正常时间更长的显著预测因素。GFDC是atTG更早恢复正常的显著预测因素（OR = 13.91[7.86 - 24.62]，P<0.001）。
GFDC和诊断时较低的atTG是atTG更早恢复正常的预测因素。T1DM患者atTG水平恢复正常的可能性较小，恢复正常的时间更长。需要对高危人群进行更多的研究和教育。
