Thawani Sujata, Brannagan Thomas H, Lebwohl Benjamin, Mollazadegan Kaziwe, Green Peter H R, Ludvigsson Jonas F
*Department of Neurology, New York University School of Medicine, New York, NY; †Department of Neurology, Columbia University College of Physicians and Surgeons, New York, NY; ‡Celiac Disease Center, Department of Medicine, Columbia University College of Physicians and Surgeons, New York, NY; §Department Medical Epidemiology and Biostatistics, Karolinska Institutet, Stockholm, Sweden; ¶Department of Pediatrics, Örebro University Hospital, Örebro University, Örebro, Sweden; and ‖Division of Epidemiology and Public Health, School of Medicine, University of Nottingham, Nottingham, United Kingdom.
J Clin Neuromuscul Dis. 2017 Sep;19(1):12-18. doi: 10.1097/CND.0000000000000174.
Both type 1 diabetes (T1D) and celiac disease (CD) have been linked to an increased risk of neuropathy. This study examined the risk of neuropathy in patients with T1D compared with patients with both T1D and CD.
In a nationwide population-based cohort, T1D was defined as having a diagnosis of diabetes between 1964 and 2009 recorded in the Swedish National Patient Register in individuals ≤30 years of age. CD was defined as having villous atrophy (Marsh histopathology stage III) on small intestinal biopsy. CD cases were identified through biopsies examined between 1969 and 2008 at any of Sweden's 28 pathology departments. Nine hundred fifty-eight patients had both T1D and CD and were matched for sex, age, and calendar period with 4590 controls who only had T1D. Through Cox regression analysis, with CD as the time-dependent covariate, we estimated the risk of neuropathy in T1D patients with CD.
Fifty-four individuals with T1D and CD had later neuropathy (expected: n = 42). This corresponded to an adjusted hazard ratio of 1.27 (95% confidence interval = 0.95-1.71) compared with those who had T1D alone. The hazard ratio was statistically significant in the first 5 years with CD (1.67; 95% confidence interval = 1.13-2.47) but decreased to neutrality thereafter. Risk estimates were similar in men and women, and did not differ by age at CD onset.
CD does not seem to influence the risk of neuropathy in individuals with T1D, although a small excess risk cannot be ruled out.
1型糖尿病（T1D）和乳糜泻（CD）均与神经病变风险增加有关。本研究比较了T1D患者与同时患有T1D和CD的患者发生神经病变的风险。
在一项基于全国人群的队列研究中，T1D被定义为1964年至2009年间在瑞典国家患者登记册中记录的30岁及以下个体被诊断为糖尿病。CD被定义为小肠活检显示绒毛萎缩（马什组织病理学III期）。通过对1969年至2008年间瑞典28个病理科中任何一个科室检查的活检样本进行分析来确定CD病例。958例患者同时患有T1D和CD，并根据性别、年龄和日历时间与4590例仅患有T1D的对照进行匹配。通过以CD作为时间依赖性协变量的Cox回归分析，我们估计了患有CD的T1D患者发生神经病变的风险。
54例患有T1D和CD的个体后来出现神经病变（预期：n = 42）。与仅患有T1D的个体相比，这相当于调整后的风险比为1.27（95%置信区间 = 0.95 - 1.71）。在患有CD的前5年中，风险比具有统计学意义（1.67；95%置信区间 = 1.13 - 2.47），但此后降至中性。男性和女性的风险估计相似，并且在CD发病时的年龄方面没有差异。
CD似乎不会影响T1D个体发生神经病变的风险，尽管不能排除存在小的额外风险。
