Institute for Children with Diabetes (ICD), Conceição Children Hospital (HCC), Conceição Hospital Group (GHC), Ministry of Health, Porto Alegre, RS, Brazil.
Pediatric Endocrinology Service, Conceição Children Hospital (HCC), Conceição Hospital Group (GHC), Ministry of Health, Porto Alegre, RS, Brazil.
Pediatr Diabetes. 2019 Jun;20(4):414-420. doi: 10.1111/pedi.12827. Epub 2019 Apr 3.
Serological screening for celiac disease (CD) allows the identification of individuals genetically predisposed, as type 1 diabetes mellitus (T1DM). However, the diagnosis is confirmed by intestinal biopsy. The aim was to determine the prevalence of immunoglobulin-A anti-tissue transglutaminase antibodies (IgA-tTG) and CD in a large cohort of young T1DM patients.
Screening for CD was randomly conducted in 881 T1DM by IgA-tTG and total IgA. Individuals with positive antibodies were referred to endoscopy/duodenal biopsy.
The age of the cohort at the screening was 14.3 ± 5.9 years and at T1DM onset was 7.9 ± 4.4 years. The prevalence of positive serology was 7.7%. Median IgA-tTG levels were 117.7 U/mL (interquartile range [IQR] 35.7-131.5 U/mL). Of the 62 duodenal biopsy, CD was diagnosed in 79.0%, yielding an overall prevalence of 5.6%. The mean age of CD patients was 15.6 ± 6.5 years and, at T1DM onset was 6.3 years (4.0-9.9 years). The modified Marsh-Oberhuber histological classification was 22.5% (3a), 36.7% (3b), and 40.8% (3c). In the biopsy-proven patients, T1DM onset occurred at slightly younger ages (6.3 vs 9.7 years, P = 0.1947), gastrointestinal (GI) manifestations, predominantly abdominal pain and distension, were more prevalent (71.4% vs 38.5%, P = 0.027) and higher IgA-tTG titers (128.0 vs 26.3 U/mL, P = 0.0003) were found than in those with negative-biopsies.
Our results demonstrate the prevalence of 7.7% of IgA-tTG and 5.6% of CD in T1DM patients in South Brazil and, emphasize the importance of the screening in high-risk individuals. Furthermore, the presence of GI manifestations and higher IgA-tTG titers strongly suggest the diagnosis of CD.
血清学筛查可识别出 1 型糖尿病（T1DM）患者中遗传易患乳糜泻（CD）的个体。然而，诊断仍需通过肠活检来确认。本研究旨在确定大量 T1DM 年轻患者中抗组织转谷氨酰胺酶抗体（IgA-tTG）和 CD 的流行率。
对 881 例 T1DM 患者进行 IgA-tTG 和总 IgA 的 CD 筛查。抗体阳性者转至内镜/十二指肠活检。
筛查时患者的年龄为 14.3 ± 5.9 岁，T1DM 发病时为 7.9 ± 4.4 岁。血清学阳性率为 7.7%。IgA-tTG 中位数为 117.7 U/mL（四分位距 35.7-131.5 U/mL）。62 例十二指肠活检中，CD 诊断率为 79.0%，总患病率为 5.6%。CD 患者的平均年龄为 15.6 ± 6.5 岁，T1DM 发病时为 6.3 岁（4.0-9.9 岁）。改良 Marsh-Oberhuber 组织学分级为 22.5%（3a）、36.7%（3b）和 40.8%（3c）。在经活检证实的患者中，T1DM 发病年龄略小（6.3 岁 vs 9.7 岁，P = 0.1947），更常见胃肠道（GI）表现，主要为腹痛和腹胀（71.4% vs 38.5%，P = 0.027），且 IgA-tTG 滴度更高（128.0 U/mL vs 26.3 U/mL，P = 0.0003）。
本研究结果显示，巴西南部 T1DM 患者的 IgA-tTG 阳性率为 7.7%，CD 阳性率为 5.6%，强调了对高危人群进行筛查的重要性。此外，GI 表现和更高的 IgA-tTG 滴度强烈提示 CD 的诊断。
