Department of pediatrics, Regional University Hospital of Nancy, Allée du Morvan, Vandoeuvre-Lès-Nancy 54511, France.
MPI department, Methodology, data management and statistic Unit, Regional University Hospital of Nancy, Vandoeuvre-Lès-Nancy, France.
Arch Pediatr. 2022 Jul;29(5):381-387. doi: 10.1016/j.arcped.2022.03.002. Epub 2022 May 27.
Patients with type 1 diabetes (T1D) are more likely to develop other autoimmune diseases than the general population.
To describe additional autoimmunity in a cohort of children and adolescents with T1D, as well as to identify factors associated with the presence of additional autoantibodies (AABs) and of additional autoimmune diseases (AADs).
This was a single-center retrospective cohort study of 179 children and adolescents (median age: 9.1 years) diagnosed with T1D between 2014 and 2020 in a specialized center in France. Patients were screened for autoimmune thyroiditis and celiac disease at T1D diagnosis and once every 1-2 years during follow-up. Other AADs and their specific autoantibodies were screened for only if clinical or laboratory signs were present.
At T1D diagnosis, 15.6% of participants presented with at least one type of AAB including antibodies specific to Hashimoto's disease (TPOAb and/or TGAb) and/or to celiac disease (tTGAb and/or EMAb). Only 2.8% of participants presented with an AAD as early as T1D diagnosis. The median follow-up was 37 months. The cumulative incidence of AABs and AADs at 2 years of follow-up was, respectively, 3.9% and 5.4%, and it doubled at 3 years of follow-up. Only one patient, also affected by Down syndrome, was diagnosed with 2 AADs. Hashimoto's disease was the most frequently diagnosed AAD, followed by celiac disease, both at an asymptomatic stage. Vitiligo and Graves' disease were also diagnosed in this cohort but affected few patients. Children aged 6-12 years were more likely to present with an AAD at diabetes diagnosis (p = 0.043).
The high prevalence and incidence of additional autoimmunity in children and adolescents with T1D justifies regular screening of AABs and AADs.
相较于普通人群，1 型糖尿病（T1D）患者更易罹患其他自身免疫性疾病。
描述 T1D 患儿和青少年群体中其他自身免疫性疾病的发病情况，并确定与存在其他自身抗体（AAB）和其他自身免疫性疾病（AAD）相关的因素。
这是一项在法国某专业中心开展的单中心回顾性队列研究，共纳入 179 例于 2014 年至 2020 年期间确诊 T1D 的儿童和青少年（中位年龄：9.1 岁）。在 T1D 确诊时以及随访期间每年或每 2 年，对患者进行自身免疫性甲状腺炎和乳糜泻筛查。仅在存在临床或实验室征象时，对其他 AAD 及其特定自身抗体进行筛查。
T1D 确诊时，15.6%的参与者至少存在 1 种 AAB，包括针对桥本甲状腺炎（TPOAb 和/或 TGAb）和/或乳糜泻（tTGAb 和/或 EMAb）的抗体。仅 2.8%的参与者在 T1D 确诊时就已患有 AAD。中位随访时间为 37 个月。随访 2 年时，AAB 和 AAD 的累积发病率分别为 3.9%和 5.4%，随访 3 年时，其发病率翻倍。仅 1 例同时患有唐氏综合征的患者被诊断出患有 2 种 AAD。桥本甲状腺炎是最常被诊断的 AAD，其次是乳糜泻，两者均处于无症状阶段。该队列中还诊断出了白癜风和格雷夫斯病，但患者人数较少。6-12 岁的儿童更有可能在糖尿病确诊时就患有 AAD（p=0.043）。
T1D 患儿和青少年中 AAB 和 AAD 的高患病率和发病率表明定期筛查 AAB 和 AAD 具有重要意义。
