School of Medicine, Division of Epidemiology and Public Health, University of Nottingham, Nottingham, UK.
National Institute for Health Research (NIHR), Nottingham Biomedical Research Centre, Nottingham, UK.
United European Gastroenterol J. 2019 Apr;7(3):377-387. doi: 10.1177/2050640618814662. Epub 2018 Nov 18.
Few studies have determined the very long-term mortality risks in adult and childhood-diagnosed coeliac disease.
We quantified mortality risks in coeliac disease and determined whether age at diagnosis, or time following diagnosis, modified these risks.
Standardised mortality ratios were determined using data from a cohort of 602 coeliac patients assembled between 1979-1983 from Lothian, Scotland, and followed up from 1970-2016.
All-cause mortality was 43% higher than in the general population. Excess deaths were primarily from haematological malignancies (standardised mortality ratio, 4.77) and external causes (standardised mortality ratio, 2.62) in adult and childhood-diagnosed cases respectively. Mortality risks declined steadily with time in adult-diagnosed cases (standardised mortality ratio, 4.85 in first year compared to 0.97, 25 years post-diagnosis). Beyond 15 years, this group had a significantly reduced risk of any malignancy (standardised mortality ratio, 0.57 (95% confidence interval: 0.33-0.92)). In contrast, for childhood-diagnosed cases an increased risk existed beyond 25 years (standardised mortality ratio, 2.24).
Adult-diagnosed coeliac patients have a temporarily increased mortality risk mainly from malignant lymphomas and a decreased risk of any malignancy beyond 15 years post-diagnosis. In contrast, childhood-diagnosed cases are at an increased risk of mortality mainly from external causes, and have long-term mortality risks that requires further investigation.
很少有研究确定成人和儿童期诊断的乳糜泻的长期死亡率风险。
我们量化了乳糜泻的死亡率，并确定了诊断时的年龄或诊断后时间是否改变了这些风险。
使用 1979-1983 年在苏格兰洛锡安收集的 602 例乳糜泻患者队列的数据，从 1970 年至 2016 年进行随访，确定标准化死亡率比。
乳糜泻患者的全因死亡率比一般人群高 43%。成人和儿童期诊断病例的超额死亡主要来自血液系统恶性肿瘤（标准化死亡率比分别为 4.77 和 2.62）和外部原因（标准化死亡率比分别为 2.62 和 2.62）。成人诊断病例的死亡率风险随时间稳步下降（第一年的标准化死亡率比为 4.85，25 年后为 0.97）。15 年以上，该组任何恶性肿瘤的风险显著降低（标准化死亡率比为 0.57（95%置信区间：0.33-0.92））。相比之下，儿童期诊断病例的风险在 25 年以上增加（标准化死亡率比为 2.24）。
成人诊断的乳糜泻患者在诊断后 15 年以上有暂时增加的死亡率风险，主要来自恶性淋巴瘤，任何恶性肿瘤的风险降低。相比之下，儿童期诊断的病例的死亡率风险主要来自外部原因，并且需要进一步调查其长期死亡率风险。
