Department of Gastroenterology and Nutrition, Department of Clinical Sciences, Skåne University Hospital, Lund University, Malmö, Sweden.
Division of Medical Microbiology, Department of Laboratory Medicine, Skåne University Hospital, Lund University, Lund, Sweden.
BMC Gastroenterol. 2023 May 22;23(1):174. doi: 10.1186/s12876-023-02795-3.
Celiac disease (CD) is an autoimmune disease leading to gastrointestinal symptoms and mineral deficiencies. The pathogenetic mechanisms, besides the clear HLA association, are elusive. Among environmental factors infections have been proposed. Covid-19 infection results in a systemic inflammatory response that often also involves the gastrointestinal tract. The aim of the present study was to investigate whether Covid-19 infection could increase the risk for CD.
All patients, both children and adults, in the county Skåne (1.4 million citizens) in southern Sweden with newly diagnosed biopsy- or serology-verified CD or a positive tissue transglutaminase antibody test (tTG-ab) during 2016-2021 were identified from registries at the Departments of Pathology and Immunology, respectively. Patients with a positive Covid-19 PCR or antigen test in 2020 and 2021 were identified from the Public Health Agency of Sweden.
During the Covid-19 pandemic (March 2020 - December 2021), there were 201 050 cases of Covid-19 and 568 patients with biopsy- or serology-verified CD or a first-time positive tTG-ab tests, of which 35 patients had been infected with Covid-19 before CD. The incidence of verified CD and tTG-ab positivity was lower in comparison to before the pandemic (May 2018 - February 2020; 22.5 vs. 25.5 cases per 100 000 person-years, respectively, incidence rate difference (IRD) -3.0, 95% CI -5.7 - -0.3, p = 0.028). The incidence of verified CD and tTG-ab positivity in patients with and without prior Covid-19 infection was 21.1 and 22.4 cases per 100 000 person-years, respectively (IRD - 1.3, 95% CI -8.5-5.9, p = 0.75).
Our results indicate that Covid-19 is not a risk factor for CD development. While gastrointestinal infections seem to be an important part of the CD pathogenesis, respiratory infections probably are of less relevance.
乳糜泻（CD）是一种自身免疫性疾病，可导致胃肠道症状和矿物质缺乏。除了明确的 HLA 相关性之外，其发病机制仍不清楚。环境因素中，感染已被提出为一个致病因素。新冠病毒感染会导致全身炎症反应，而这种反应通常也会涉及胃肠道。本研究旨在探讨新冠病毒感染是否会增加 CD 的发病风险。
从病理和免疫学部的登记处分别鉴定出 2016 年至 2021 年期间在瑞典斯科讷县（140 万居民）新诊断出活检或血清学证实的 CD 或组织转谷氨酰胺酶抗体检测（tTG-ab）阳性的所有患者，包括儿童和成人。从瑞典公共卫生局鉴定出 2020 年和 2021 年新冠病毒 PCR 或抗原检测阳性的患者。
在新冠疫情期间（2020 年 3 月至 2021 年 12 月），有 201050 例新冠病例和 568 例活检或血清学证实的 CD 或首次 tTG-ab 阳性患者，其中 35 例患者在 CD 之前曾感染过新冠病毒。与疫情前（2018 年 5 月至 2020 年 2 月）相比，确诊 CD 和 tTG-ab 阳性的发病率较低（分别为每 100000 人年 22.5 例和 25.5 例，发病率差异（IRD）-3.0，95%CI-5.7 至-0.3，p=0.028）。有和没有新冠病毒感染史的患者中确诊 CD 和 tTG-ab 阳性的发病率分别为每 100000 人年 21.1 例和 22.4 例（IRD-1.3，95%CI-8.5 至 5.9，p=0.75）。
我们的结果表明新冠病毒不是 CD 发病的危险因素。虽然胃肠道感染似乎是 CD 发病机制的重要组成部分，但呼吸道感染的相关性可能较小。
