Björck Sara, Brundin Charlotte, Karlsson Magnus, Agardh Daniel
*Unit of Diabetes and Celiac Disease, Department of Clinical Sciences, Lund University, Malmö †Clinical and Molecular Osteoporosis Research Unit, Department of Clinical Sciences and Orthopedics, Lund University, Malmö, Sweden.
J Pediatr Gastroenterol Nutr. 2017 Nov;65(5):526-532. doi: 10.1097/MPG.0000000000001568.
The aim of the study was to assess whether bone mass and metabolism are impaired in genetically at-risk children with screening-detected celiac disease.
Included were 71 children with screening-detected celiac disease diagnosed at 10.0 ± 0.7 (mean ± standard deviation) years and 142 matched controls and 30 children with screening-detected celiac disease diagnosed at 3.3 ± 0.4 years of age presently on a gluten-free diet for 6.9 ± 1.1 years and 60 matched controls. All participants were assessed for bone mineral density (BMD) of total body and spine by dual x-ray absorptiometry, serum 25(OH) vitamin D3, parathyroid hormone (PTH), interleukin (IL)-1β, IL-2, IL-4, IL-5, IL-6, IL-8, IL-10, IL-12p70, IL-13, IL-15, interferon gamma, and tumor necrosis factor alpha.
At diagnosis, screening-detected celiac disease children as compared to controls had a mean -0.03 g/cm reduced BMD of both total body and spine (P = 0.009 and P = 0.005, respectively), a mean -11.4 nmol/L lower level of 25(OH) vitamin D3 (P < 0.001), and a mean +1.0 pmol/L higher PTH level (P < 0.001). Systemic levels of the cytokines IL-1β, IL-6, IL-8, IL-10, IL-12p70, IL-13, and tumor necrosis factor alpha were all increased in screening-detected celiac disease as compared to controls (P < 0.001). No difference in BMD, 25(OH) vitamin D3, PTH, and cytokine levels were detected in children on a gluten-free diet compared with controls.
Children with screening-detected celiac disease have reduced BMD, lower levels of vitamin D3, higher levels of PTH, and signs of systemic inflammation compared with controls. These differences were not found in celiac disease children on a gluten-free diet, indicating that children with screening-detected celiac disease benefit from an early diagnosis and treatment.
本研究旨在评估经筛查发现患有乳糜泻的遗传易患儿童的骨量和骨代谢是否受损。
纳入71名经筛查发现患有乳糜泻的儿童，其诊断年龄为10.0±0.7（均值±标准差）岁，另有142名匹配的对照儿童；以及30名经筛查发现患有乳糜泻的儿童，其诊断年龄为3.3±0.4岁，目前已接受无麸质饮食6.9±1.1年，另有60名匹配的对照儿童。所有参与者均通过双能X线吸收法评估全身和脊柱的骨密度（BMD），检测血清25(OH)维生素D3、甲状旁腺激素（PTH）、白细胞介素（IL）-1β、IL-2、IL-4、IL-5、IL-6、IL-8、IL-10、IL-12p70、IL-13、IL-15、干扰素γ和肿瘤坏死因子α。
在诊断时，经筛查发现患有乳糜泻的儿童与对照儿童相比，全身和脊柱的骨密度平均降低0.03 g/cm（分别为P = 0.009和P = 0.005），25(OH)维生素D3水平平均降低11.4 nmol/L（P < 0.001），PTH水平平均升高1.0 pmol/L（P < 0.001）。与对照儿童相比，经筛查发现患有乳糜泻的儿童体内细胞因子IL-1β、IL-6、IL-8、IL-10、IL-12p70、IL-13和肿瘤坏死因子α的全身水平均升高（P < 0.001）。与对照儿童相比，接受无麸质饮食的儿童在骨密度、25(OH)维生素D3、PTH和细胞因子水平方面未检测到差异。
与对照儿童相比，经筛查发现患有乳糜泻的儿童骨密度降低、维生素D3水平降低、PTH水平升高且有全身炎症迹象。在接受无麸质饮食的乳糜泻儿童中未发现这些差异，这表明经筛查发现患有乳糜泻的儿童可从早期诊断和治疗中获益。
