Jansen Michelle A E, Beth Sytske A, van den Heuvel Diana, Kiefte-de Jong Jessica C, Raat Hein, Jaddoe Vincent W V, van Zelm Menno C, Moll Henriette A
The Generation R Study Group, Erasmus MC, University Medical Center, Rotterdam, The Netherlands.
Department of Paediatrics, Erasmus MC, University Medical Center, Rotterdam, The Netherlands.
Arch Dis Child. 2017 Jun;102(6):529-534. doi: 10.1136/archdischild-2016-311343. Epub 2017 Jan 4.
The aim was to identify whether ethnic differences in coeliac disease autoimmunity (CDA) in children at 6 years of age exist, and when present, to evaluate how these differences may be explained by sociodemographic and environmental factors.
This study was embedded within a multi-ethnic population-based prospective cohort study.
4442 six-year-old children born between 2002 and 2006 were included. Information on ethnicity, environmental and lifestyle characteristics was assessed by questionnaires. Ethnicity was categorised into Western (Dutch, European, Indonesian, American, Oceanian) and non-Western (Turkish, Moroccan, Cape Verdean, Antillean, Surinamese). Serum transglutaminase type 2 antibody (TG2A) levels were measured with fluorescence enzyme immunoassay. Serum IgG levels against cytomegalovirus (CMV) were measured by ELISA.
TG2A positivity was defined as TG2A ≥7 U/mL, strong TG2A positivity as TG2A ≥10 upper limit normal (70 U/mL).
Of 4442 children, 60 (1.4%) children were TG2A positive, of whom 31 were strong positive. 66% of children were Western, 33% non-Western. Western ethnicity, high socioeconomic position and daycare attendance were positively associated with strong TG2A positivity (odds ratio (OR) 6.85 (1.62 to 28.8) p<0.01, OR 3.70 (1.40 to 9.82) p<0.01, OR 3.90 (1.38 to 11.0) p=0.01 resp.), whereas CMV seropositivity was inversely related to strong TG2A positivity (OR 0.32 (0.12 to 0.84) p=0.02). Together, these factors explained up to 47% (-67 to -17; p=0.02) of the ethnic differences in TG2A positivity between Western and non-Western children.
Ethnic differences in children with CDA are present in childhood. Socioeconomic position, daycare attendance and CMV seropositivity partly explained these differences, which may serve as targets for prevention strategies for CDA.
旨在确定6岁儿童乳糜泻自身免疫（CDA）是否存在种族差异，若存在，评估社会人口统计学和环境因素如何解释这些差异。
本研究纳入了一项基于多民族人群的前瞻性队列研究。
纳入了4442名2002年至2006年出生的6岁儿童。通过问卷调查评估种族、环境和生活方式特征。种族分为西方（荷兰、欧洲、印度尼西亚、美国、大洋洲）和非西方（土耳其、摩洛哥、佛得角、安的列斯、苏里南）。采用荧光酶免疫测定法检测血清组织转谷氨酰胺酶2抗体（TG2A）水平。采用酶联免疫吸附测定法检测血清抗巨细胞病毒（CMV）IgG水平。
TG2A阳性定义为TG2A≥7 U/mL，强TG2A阳性定义为TG2A≥10倍正常上限（70 U/mL）。
在4442名儿童中，60名（1.4%）儿童TG2A阳性，其中31名强阳性。66%的儿童为西方种族，33%为非西方种族。西方种族、高社会经济地位和日托参与与强TG2A阳性呈正相关（优势比（OR）分别为6.85（1.62至28.8），p<0.01；OR 3.70（1.40至9.82），p<0.01；OR 3.（1.38至11.0），p=0.01），而CMV血清阳性与强TG2A阳性呈负相关（OR 0.32（0.12至0.84），p=0.02）。这些因素共同解释了西方和非西方儿童之间TG2A阳性种族差异的47%（-67至-17；p=0.02）。
CDA儿童的种族差异在儿童期存在。社会经济地位、日托参与和CMV血清阳性部分解释了这些差异，这可能成为CDA预防策略的目标。
