Celiac Disease Research Center, Faculty of Medicine and Health Technology, Tampere University, Tampere, Finland.
Department of Dermatology, Tampere University Hospital, Tampere, Finland.
Ann Med. 2023 Dec;55(1):2227423. doi: 10.1080/07853890.2023.2227423.
Dermatitis herpetiformis (DH) is a cutaneous manifestation of coeliac disease. Increased cardiovascular morbidity has been reported in coeliac disease, but in DH only little is known about this. In this cohort study with a long-term follow-up, the risk for vascular diseases in patients with dermatitis herpetiformis (DH) and coeliac disease was assessed.
The study consisted of 368 DH and 1072 coeliac disease patients with biopsy-proven diagnosis performed between 1966 and 2000. For each DH and coeliac disease patient three matched reference individuals were obtained from the population register. Data regarding all outpatient and inpatient treatment periods between 1970 and 2015 were reviewed for diagnostic codes of vascular diseases from the Care Register for Health Care. Cox proportional hazard model was used to assess the risks for the diseases studied and the HRs were adjusted for diabetes mellitus (aHR).
The median follow-up time of DH and coeliac disease patients was 46 years. The risk for cardiovascular diseases did not differ between DH patients and their references (aHR 1.16, 95% CI 0.91-1.47), but among coeliac disease patients, the risk was increased (aHR 1.36, 95% CI 1.16-1.59). The risk for cerebrovascular diseases was found to be decreased in DH patients when compared with references (aHR 0.68, 95% CI 0.47-0.99) and increased in coeliac disease patients (aHR 1.33, 95% CI 1.07-1.66). The risk for venous thrombosis was increased in coeliac disease patients (aHR 1.62, 95% CI 1.22-2.16) but not in DH.
The risk for vascular complications appears to differ between DH and coeliac disease. In DH the risk for cerebrovascular diseases seems to be decreased, while in coeliac disease an elevated risk for cerebrovascular and cardiovascular diseases was observed. These differing vascular risk profiles between the two manifestations of the same disease merit further investigation.
疱疹样皮炎（DH）是乳糜泻的一种皮肤表现。乳糜泻患者的心血管发病率增加已有报道，但在 DH 中，对此知之甚少。在这项长期随访的队列研究中，评估了疱疹样皮炎（DH）和乳糜泻患者的血管疾病风险。
该研究包括 368 例 DH 和 1072 例乳糜泻患者，均于 1966 年至 2000 年间行活检确诊。为每位 DH 和乳糜泻患者从人群登记处获得了 3 名匹配的参考个体。回顾了 1970 年至 2015 年所有门诊和住院治疗期间的医疗记录，以查看保健登记处中血管疾病的诊断代码。使用 Cox 比例风险模型评估所研究疾病的风险，并用糖尿病（调整后的 HR[aHR]）对 HR 进行调整。
DH 和乳糜泻患者的中位随访时间为 46 年。DH 患者与参考个体之间的心血管疾病风险无差异（aHR 1.16，95%CI 0.91-1.47），但乳糜泻患者的风险增加（aHR 1.36，95%CI 1.16-1.59）。与参考个体相比，DH 患者的脑血管疾病风险降低（aHR 0.68，95%CI 0.47-0.99），而乳糜泻患者的风险增加（aHR 1.33，95%CI 1.07-1.66）。静脉血栓形成的风险在乳糜泻患者中增加（aHR 1.62，95%CI 1.22-2.16），但在 DH 患者中没有增加。
DH 和乳糜泻的血管并发症风险似乎不同。在 DH 中，脑血管疾病的风险似乎降低，而在乳糜泻中，观察到脑血管和心血管疾病的风险增加。同一疾病的两种表现形式之间存在不同的血管风险谱，值得进一步研究。
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