Department of Experimental Medicine, Sapienza University of Rome, Rome, Italy.
Department of Pediatrics, Pediatric Gastroenterology, and Liver Unit, Sapienza University of Rome, Rome, Italy.
Pediatr Diabetes. 2020 Aug;21(5):774-780. doi: 10.1111/pedi.13054. Epub 2020 Jun 8.
Almost 6% of celiac disease (CD) patients at diagnosis are positive for at least one of the main pancreatic islet autoantibodies that characterize type 1 diabetes (T1D). Few information, dated back to almost two decades ago, exist as to whether a gluten-free diet (GFD) could reduce the islet-specific autoimmunity detected in patients at CD diagnosis. Aim of the study was to evaluate the impact of GFD on 31 patients who presented islet-specific autoimmunity at CD diagnosis.
CD patient sera collected at diagnosis and throughout the GFD were analyzed for the main humoral autoantibodies so far identified in T1D, directed against one or more among insulin, glutamic-acid decarboxylase, tyrosine-phosphatase 2, and zinc cation-efflux transporter autoantigens.
GFD (median duration 39 months) was associated to a decrease or disappearance of the islet-specific autoantibodies in 71% of CD patients. Almost 80% of the patients who became autoantibody-negative during the GFD were positive for only one of the islet-specific autoimmune markers at CD diagnosis, with none of them developing diabetes. Conversely, 80% of the CD patients positive at diagnosis for ≥2 islet-specific autoantibodies were still positive after more than two years of GFD, with 25% of them developing T1D.
Various factors appear to influence, individually or in combination, the effects of the GFD on pancreatic islet-specific autoimmune response detected at CD diagnosis. These factors include the number of diabetes autoantibodies found at CD diagnosis, the adherence to the GFD, its duration and an asymptomatic clinical presentation of CD.
在诊断为乳糜泻 (CD) 的患者中，约有 6%至少有一种特征性 1 型糖尿病 (T1D) 的主要胰岛自身抗体呈阳性。关于无麸质饮食 (GFD) 是否能降低 CD 诊断时检测到的胰岛特异性自身免疫，几乎没有 20 年前的信息。本研究旨在评估 GFD 对 31 例在 CD 诊断时存在胰岛特异性自身免疫的患者的影响。
在 CD 诊断时和整个 GFD 期间收集 CD 患者的血清，用于分析迄今为止在 T1D 中鉴定出的主要体液自身抗体，这些抗体针对胰岛素、谷氨酸脱羧酶、酪氨酸磷酸酶 2 和锌阳离子外排转运体自身抗原中的一种或多种。
GFD（中位数持续时间 39 个月）与 71%的 CD 患者的胰岛特异性自身抗体减少或消失相关。在 GFD 期间成为自身抗体阴性的患者中，几乎 80%在 CD 诊断时仅有一种胰岛特异性自身免疫标志物呈阳性，且无一人发生糖尿病。相反，在 CD 诊断时对≥2 种胰岛特异性自身抗体呈阳性的 CD 患者中，80%在超过两年的 GFD 后仍呈阳性，其中 25%发生 T1D。
各种因素似乎单独或联合影响 GFD 对 CD 诊断时检测到的胰腺胰岛特异性自身免疫反应的影响。这些因素包括在 CD 诊断时发现的糖尿病自身抗体数量、对 GFD 的依从性、其持续时间以及 CD 的无症状临床表现。
