Celiac Disease Center, Department of Medicine, Columbia University Medical Center, New York, New York; Department of Epidemiology, Mailman School of Public Health, Columbia University, New York, New York.
Department Medical Epidemiology and Biostatistics, Karolinska Institutet, Stockholm, Sweden.
Clin Gastroenterol Hepatol. 2021 Oct;19(10):2093-2101.e13. doi: 10.1016/j.cgh.2020.08.018. Epub 2020 Aug 12.
BACKGROUND & AIMS: Few studies have explored the link between childhood celiac disease and long-term psychiatric comorbidities. We performed a population-based cohort study of associations between childhood celiac disease and psychiatric disorders and investigated whether risk persists into adulthood.
We performed a nationwide study in Sweden using data from the Epidemiology Strengthened by histoPathology Reports in Sweden cohort. In this cohort, 19,186 children with a diagnosis of biopsy-verified celiac disease from 1973 through 2016 were identified from Sweden's 28 pathology departments. Each patient was matched with as many as 5 reference children (controls, n = 94,249). Data on psychiatric disorders were obtained from the patient register. We used Cox proportional modeling to estimate hazard ratios (HRs).
During a median follow-up period of 12.3 years, 3174 children (16.5%) with celiac disease received a new diagnosis of a psychiatric disorder, compared with 13,286 controls (14.1%). Corresponding incidence rates were 12.2 per 1000 person-years (95% CI, 11.8-12.7) vs 10.3 per 1000 person-years (95% Cl, 10.2-10.5). Childhood celiac disease was associated with a 19% increase in risk of any psychiatric disorder (95% CI, 1.14-1.23); the increase in risk was observed in all childhood age groups. The highest HRs were seen in the first year after celiac diagnosis (HR, 1.70; 95% CI, 1.41-2.05). The risk increase persisted into adulthood (age, >18 y: HR, 1.11; 95% CI, 1.04-1.17). We found increased risks of mood disorders (HR, 1.20; 95% CI, 1.12-1.28), anxiety disorders (HR, 1.12; 95% CI, 1.06-1.19), eating disorders (HR, 1.34; 95% CI, 1.18-1.51), attention deficit hyperactivity disorder (HR, 1.29; 95% CI, 1.20-1.39), and autism spectrum disorder (HR, 1.47; 95% CI, 1.32-1.64). We found no statistically significant risk increase for psychotic disorders, psychoactive substance misuse, behavioral disorders, personality disorders, suicide attempt, or suicide. Celiac disease also was linked to an increased use of psychiatric drugs (HR, 1.34; 95% CI, 1.24-1.43). A conditional logistic regression found that psychiatric disorders also were more common before a diagnosis of celiac disease (odds ratio, 1.56; 95% CI, 1.39-1.76).
Childhood celiac disease is associated with an increased risk of subsequent psychiatric disorders, which persists into adulthood. Mental health surveillance should be integral in the care of celiac disease.
很少有研究探讨儿童乳糜泻与长期精神共病之间的联系。我们进行了一项基于人群的队列研究，探讨了儿童乳糜泻与精神障碍之间的关联，并调查了这种风险是否持续到成年期。
我们在瑞典使用来自瑞典组织病理学报告强化流行病学研究队列的数据进行了一项全国性研究。在该队列中，从瑞典的 28 个病理部门中确定了 19186 名经活检证实的乳糜泻患儿（1973 年至 2016 年）。每位患者最多可以与 5 名参考儿童（对照组，n=94249）相匹配。精神障碍数据来自患者登记处。我们使用 Cox 比例风险模型估计风险比（HR）。
在中位随访 12.3 年期间，3174 名（16.5%）乳糜泻患儿新诊断出精神障碍，而对照组为 13286 名（14.1%）。相应的发病率为每 1000 人年 12.2 例（95%CI，11.8-12.7）vs. 每 1000 人年 10.3 例（95%CI，10.2-10.5）。儿童乳糜泻与任何精神障碍风险增加 19%（95%CI，1.14-1.23）相关；在所有儿童年龄组中均观察到风险增加。在乳糜泻诊断后的第一年，风险最高（HR，1.70；95%CI，1.41-2.05）。这种风险增加持续到成年期（年龄>18 岁：HR，1.11；95%CI，1.04-1.17）。我们发现情绪障碍（HR，1.20；95%CI，1.12-1.28）、焦虑障碍（HR，1.12；95%CI，1.06-1.19）、饮食障碍（HR，1.34；95%CI，1.18-1.51）、注意缺陷多动障碍（HR，1.29；95%CI，1.20-1.39）和自闭症谱系障碍（HR，1.47；95%CI，1.32-1.64）的风险增加。我们没有发现精神病、精神活性物质滥用、行为障碍、人格障碍、自杀未遂或自杀的风险增加具有统计学意义。乳糜泻也与精神药物使用增加有关（HR，1.34；95%CI，1.24-1.43）。条件逻辑回归发现，在乳糜泻诊断之前，精神障碍也更为常见（比值比，1.56；95%CI，1.39-1.76）。
儿童乳糜泻与随后发生精神障碍的风险增加相关，这种风险持续到成年期。在乳糜泻的治疗中，应将精神健康监测作为一个重要的组成部分。
