Saukkonen T, Savilahti E, Reijonen H, Ilonen J, Tuomilehto-Wolf E, Akerblom H K
Children's Hospital, I Department of Pediatrics, University of Helsinki, Finland.
Diabet Med. 1996 May;13(5):464-70. doi: 10.1002/(SICI)1096-9136(199605)13:5<464::AID-DIA101>3.0.CO;2-R.
Coeliac disease was searched for in a series of 776 children with newly diagnosed IDDM. During the follow-up of 2 to 3 years from diagnosis, reticulin and gliadin antibodies were measured, and a jejunal biopsy was performed in those cases with high levels of antibodies; 19 children were identified with coeliac disease, giving the prevalence of 2.4%. In only one case had coeliac disease been diagnosed before IDDM. Nine patients with proven coeliac disease were negative for antibodies when IDDM was diagnosed, but became positive within 24 months. All patients found to have coeliac disease were positive for IgA reticulin antibodies, but only 12 of 18 (67%) showed a high level of IgA gliadin antibodies. Of the 18 patients genotyped for HLA DR locus, 14 (78%) were positive for DR3 and 10 (56%) were positive for DR4. DQB1*0201 allele was present in 17 of 18 patients (94%). Coeliac disease in children with IDDM tends to develop soon after diabetes is diagnosed. Routine screening for coeliac disease is recommended repeatedly during the first years after the diagnosis of IDDM.
在776例新诊断为胰岛素依赖型糖尿病（IDDM）的儿童中筛查了乳糜泻。在诊断后的2至3年随访期间，检测了网硬蛋白和麦醇溶蛋白抗体，并对抗体水平高的病例进行了空肠活检；19名儿童被确诊为乳糜泻，患病率为2.4%。仅1例在IDDM之前就已诊断出乳糜泻。9例确诊为乳糜泻的患者在诊断IDDM时抗体呈阴性，但在24个月内转为阳性。所有被发现患有乳糜泻的患者IgA网硬蛋白抗体均为阳性，但18例中有12例（67%）IgA麦醇溶蛋白抗体水平高。在18例进行HLA DR位点基因分型的患者中，14例（78%）DR3阳性，10例（56%）DR4阳性。18例患者中有17例（94%）存在DQB1*0201等位基因。IDDM儿童中的乳糜泻往往在糖尿病诊断后不久就会发生。建议在IDDM诊断后的头几年反复进行乳糜泻的常规筛查。
