Niknam Ramin, Seraj Seyed Reza, Fattahi Mohammad Reza, Nejati Mohammadali, Dehghani Seyed-Mohsen, Mahmoudi Laleh
Gastroenterohepatology Research Center, Shiraz University of Medical Sciences, Shiraz, Iran.
Department of Clinical Pharmacy, School of Pharmacy, Shiraz University of Medical Sciences, Shiraz, Iran.
Pediatr Gastroenterol Hepatol Nutr. 2021 Mar;24(2):197-206. doi: 10.5223/pghn.2021.24.2.197. Epub 2021 Mar 8.
Celiac disease (CD) is a common autoimmune disease with extra-intestinal manifestations, including neurological disorders. There are few reports to assess various factors in increasing the chances of developing neurological disorders in CD, so we designed this study.
All patients with CD at any age who had been referred to the Celiac Clinic were evaluated for neurological problems. CD was defined as IgA anti-transglutaminase antibodies (anti-tTG) of 18 IU/mL or higher in serology and Marsh type I or more severe in histopathological evaluation. Logistic regression analysis was used to evaluate the impact of various independent variables on the neurological manifestations.
A total of 540 patients enrolled in this study. A 360 (66.7%) of patients were children. A 64.8% and 35.2% were female and male, respectively. Overall, 34.1% of patients had neurological manifestation, including headache, neuropathy, epilepsy, and ataxia. The odds of developing neurological manifestations in children were significantly lower than in adults (odds ratio [OR], 0.66; 95% confidence interval [CI], 0.45-0.96; =0.03) and in patients with gastrointestinal (GI) symptoms significantly higher than in the group without GI manifestations (OR, 1.77; 95% CI, 1.18-2.63; =0.005). Other variables, including Marsh classification (OR, 0.44; 95% CI, 0.18-1.11; =0.08) and anti-tTG levels (OR, 1.00; 95% CI, 0.999-1.001; =0.59) did not significantly increase the chances of developing neurological disorders.
Our study showed that increasing age and the presence of GI symptoms, but not serological and histological findings, could increase the chances of developing neurological diseases in CD patients.
乳糜泻（CD）是一种常见的自身免疫性疾病，伴有肠外表现，包括神经系统疾病。评估增加CD患者发生神经系统疾病几率的各种因素的报告较少，因此我们设计了本研究。
对所有转诊至乳糜泻诊所的各年龄段CD患者进行神经系统问题评估。CD的定义为血清学中IgA抗转谷氨酰胺酶抗体（抗tTG）≥18 IU/mL，组织病理学评估为Marsh I型或更严重。采用逻辑回归分析评估各种自变量对神经表现的影响。
本研究共纳入540例患者。其中360例（66.7%）为儿童。女性和男性分别占64.8%和35.2%。总体而言，34.1%的患者有神经表现，包括头痛、神经病变、癫痫和共济失调。儿童发生神经表现的几率显著低于成人（优势比[OR]，0.66；95%置信区间[CI]，0.45 - 0.96；P = 0.03），有胃肠道（GI）症状的患者显著高于无GI表现的组（OR，1.77；95% CI，1.18 - 2.63；P = 0.005）。其他变量，包括Marsh分级（OR，0.44；95% CI，0.18 - 1.11；P = 0.08）和抗tTG水平（OR，1.00；95% CI，0.999 - 1.001；P = 0.59）并未显著增加发生神经系统疾病的几率。
我们的研究表明，年龄增长和存在GI症状会增加CD患者发生神经系统疾病的几率，而血清学和组织学检查结果则不会。
