Sharma Balram, Nehara Hardeva R, Saran Sanjay, Bhavi Vijay K, Singh Anshul K, Mathur Sandeep K
Department of Endocrinology, SMS Medical College and Hospitals, JLN Road, Jaipur, Rajasthan, India.
Indian J Endocrinol Metab. 2019 Jan-Feb;23(1):22-26. doi: 10.4103/ijem.IJEM_103_18.
Type 1 diabetes mellitus (T1DM) is associated with various autoimmune disorders like celiac disease, thyroid disorder, adrenal failure, etc. However, how common is this association in Indian children is not clearly known.
To assess the prevalence of other coexisting autoimmune disorders in children with T1DM.
In this cross-sectional study, patients requiring insulin and ketosis-prone diabetic and with history of diabetic ketoacidosis/undetectable fasting C-peptide levels were included. Beside demographic and clinical data, detailed biochemistry evaluations were performed. Celiac disease was diagnosed as per the ESPGHAN diagnostic criteria. ACTH stimulation test was done to confirm the adrenal insufficiency in patients with basal serum cortisol <5 μg/dL. Thyroid function test (TSH) and anti-TPO antibody were assessed in all patients. Screening for other autoimmune disorders was done only when clinically indicated or symptoms or family history was suggestive of presence of such disorder.
Among 150 patients enrolled, 64.66% were males and mean age was 13.48 ± 3.29 years (range 3-18 years). Mean age at diagnosis of T1DM was 10.0 ± 3.63 years and duration of diabetes was 3.46 ± 3.18 years. The prevalence of antibodies positive against autoimmune diseases was anti-tTG IgA (20.7%), anti-TPO (33.7%), anti-CCP ab (1.3%), and ANA (0.7%). Significantly higher proportion of females had raised anti-TPO antibodies than males (47.2% vs. 25.8%, = 0.006). Celiac disease was most common association (24.8%) followed by hypothyroidism (14.1%) and Grave's disease (3.3%). Significantly higher proportion of females had hypothyroidism than males (25.0% vs. 8.2%, respectively, = 0.005). Prevalence of raised anti-tTG and anti-TPO did not differ significantly by the age ( = 0.841 and = 0.067) or duration of T1DM ( = 0.493 and = 0.399).
In this part of country, celiac disease, hypothyroidism, and Graves's disease are common associations in children with T1DM.
1型糖尿病（T1DM）与多种自身免疫性疾病相关，如乳糜泻、甲状腺疾病、肾上腺功能衰竭等。然而，这种关联在印度儿童中的普遍程度尚不清楚。
评估T1DM患儿中其他并存的自身免疫性疾病的患病率。
在这项横断面研究中，纳入了需要胰岛素治疗且易发生酮症的糖尿病患者，以及有糖尿病酮症酸中毒病史/空腹C肽水平检测不到的患者。除了人口统计学和临床数据外，还进行了详细的生化评估。乳糜泻根据欧洲儿科胃肠病、肝病和营养学会（ESPGHAN）诊断标准进行诊断。对基础血清皮质醇<5μg/dL的患者进行促肾上腺皮质激素（ACTH）刺激试验以确诊肾上腺功能不全。对所有患者进行甲状腺功能测试（促甲状腺激素[TSH]）和抗甲状腺过氧化物酶（TPO）抗体检测。仅在临床提示或症状或家族史提示存在此类疾病时才进行其他自身免疫性疾病的筛查。
在纳入的150例患者中，64.66%为男性，平均年龄为13.48±3.29岁（范围3 - 18岁）。T1DM诊断时的平均年龄为10.0±3.63岁，糖尿病病程为3.46±3.18年。自身免疫性疾病抗体阳性率分别为抗组织转谷氨酰胺酶（tTG）IgA（20.7%）、抗TPO（33.7%）、抗环瓜氨酸肽抗体（CCP ab）（1.3%）和抗核抗体（ANA）（0.7%）。女性抗TPO抗体升高比例显著高于男性（47.2%对25.8%，P = 0.006）。乳糜泻是最常见的关联疾病（24.8%），其次是甲状腺功能减退（14.1%）和格雷夫斯病（3.3%）。女性甲状腺功能减退的比例显著高于男性（分别为25.0%对8.2%，P = 0.005）。抗tTG和抗TPO升高的患病率在年龄（P = 0.841和P = 0.067）或T1DM病程（P = 0.493和P = 0.399）方面无显著差异。
在该国的这一地区，乳糜泻、甲状腺功能减退和格雷夫斯病是T1DM患儿中常见的关联疾病。
