Sigurs N, Johansson C, Elfstrand P O, Viander M, Lanner A
Department of Pediatrics, Bordås Hospital, Sweden.
Acta Paediatr. 1993 Sep;82(9):748-51. doi: 10.1111/j.1651-2227.1993.tb12551.x.
The aim of this study was to determine the minimum prevalence of coeliac disease in a group of 459 diabetic children and adolescents. Six patients were already known to have coeliac disease. A total of 436 patients with type 1 diabetes mellitus aged 2-21 years and with age at onset at 2 months to 17 years at three paediatric departments agreed to participate in the study. All patients were tested for gliadin IgA antibodies with a commercial kit (Pharmacia Gluten IgA EIA). Later, serum was tested for reticulin IgA/IgG antibodies. Nineteen patients had elevated gliadin IgA levels (> 25 AU). Eighteen underwent jejunal biopsy. Ten had total or subtotal villous atrophy. These 10 patients were reticulin IgA-positive. Of 417 gliadin IgA-negative patients, 408 were reticulin IgA/IgG-negative. Of 6 reticulin IgA-positive patients, 3 had total or subtotal villous atrophy. All 3 had become gliadin IgA-positive at the time of biopsy. Among 3 reticulin IgG-positive patients with IgA deficiency, 2 had total villous atrophy: 1 was not willing to be biopsied. Patients with total or subtotal villous atrophy were judged as having coeliac disease and were recommended a gluten-free diet. Within 2 months, gliadin IgA levels were normal in patients adhering to the diet. Five patients have gone through a second jejunal biopsy to date with normal histology in all 5. The 15 newly diagnosed patients with coeliac disease plus 6 already known patients with coeliac disease and type 1 diabetes mellitus gave a minimum prevalence of coeliac disease in diabetic children and adolescents of 21/459 = 4.6%.
本研究的目的是确定459名糖尿病儿童和青少年群体中乳糜泻的最低患病率。已知有6名患者患有乳糜泻。三个儿科部门中共有436名年龄在2至21岁、发病年龄在2个月至17岁的1型糖尿病患者同意参与本研究。所有患者均使用商用试剂盒（Pharmacia谷蛋白IgA酶免疫测定法）检测麦醇溶蛋白IgA抗体。随后，检测血清中的网硬蛋白IgA/IgG抗体。19名患者的麦醇溶蛋白IgA水平升高（>25 AU）。18名患者接受了空肠活检。10名患者有完全或部分绒毛萎缩。这10名患者的网硬蛋白IgA呈阳性。在417名麦醇溶蛋白IgA阴性的患者中，408名患者的网硬蛋白IgA/IgG呈阴性。在6名网硬蛋白IgA呈阳性的患者中，3名有完全或部分绒毛萎缩。所有这3名患者在活检时麦醇溶蛋白IgA都呈阳性。在3名IgA缺乏的网硬蛋白IgG呈阳性的患者中，2名有完全绒毛萎缩：1名不愿意接受活检。有完全或部分绒毛萎缩的患者被判定为患有乳糜泻，并被建议采用无麸质饮食。在2个月内，坚持饮食的患者麦醇溶蛋白IgA水平恢复正常。迄今为止，5名患者接受了第二次空肠活检，所有5名患者的组织学检查均正常。15名新诊断出的乳糜泻患者加上6名已知患有乳糜泻和1型糖尿病的患者，得出糖尿病儿童和青少年中乳糜泻的最低患病率为21/459 = 4.6%。
