Initial screening for celiac disease antibodies in children and adolescents with new-onset type 1 diabetes mellitus and their relationship with lipids
张珺 1雷珂 2田飞 1张丽娟 1王彩霞 1陈志红 1张志巍
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作者信息
1. 青岛大学附属医院儿童内分泌代谢消化科，青岛 266000
2. 青岛大学附属医院医学研究中心，青岛 266000
折叠
摘要
目的 初步筛查新发1型糖尿病（T1DM）儿童青少年乳糜泻抗体并探讨其与血脂的关系。 方法 为横断面研究。选择2013年3月至2021年1月就诊于青岛大学附属医院儿童内分泌代谢消化科的98例新发T1DM儿童青少年作为研究对象。收集患儿的一般资料［年龄、性别、血压、糖尿病酮症酸中毒（DKA）发生率等］和实验室指标［血脂（甘油三酯、总胆固醇、高密度脂蛋白胆固醇、低密度脂蛋白胆固醇、脂蛋白α）、糖化血红蛋白（HbA1c）、谷氨酸脱羧酶抗体（GADA）、胰岛素自身抗体（IAA）等］，并计算体重指数标准差积分（BMI-SDS）、动脉粥样硬化指数。采用散射比浊法检测血清总免疫球蛋白A（IgA），酶联免疫吸附法检测血清组织型转谷氨酰胺酶抗体-IgA（tTGA-IgA），间接免疫荧光法检测血清肌内膜抗体-IgA（EMA-IgA），根据tTGA-IgA和EMA-IgA检测结果将T1DM患儿分为抗体阳性组和抗体阴性组，组间比较采用独立样本t检验、Wilcoxon秩和检验、χ2检验、矫正χ2检验。 结果 98例新发T1DM儿童青少年的平均年龄为（9.38±3.56）岁，男53例、女45例，男女比例为1.18∶1。抗体阳性组8例（8.16%），年龄（8.07±4.12）岁，男6例、女2例，男女比例为3∶1，其中单纯tTGA-IgA阳性2例、单纯EMA-IgA阳性2例，tTGA-IgA和EMA-IgA同时阳性4例。抗体阴性组90例（91.84%），年龄（9.50±3.51）岁，男47例、女43例，男女比例为1.09∶1。抗体阳性组和抗体阴性组T1DM患儿性别、年龄、BMI-SDS、HbA1c、GADA阳性率、IAA阳性率、DKA的发生率以及血压之间差异均无统计学意义（P>0.05），两组患儿的甘油三酯、总胆固醇、高密度脂蛋白胆固醇、低密度脂蛋白胆固醇、脂蛋白α、动脉粥样硬化指数之间差异也无统计学意义（均P>0.05）。 结论 本中心筛查的新发T1DM儿童青少年乳糜泻抗体阳性率为8.16%，乳糜泻抗体阳性与否对新发T1DM儿童青少年血脂没有显著影响。 Objective To initially screen children and adolescents with new-onset type 1 diabetes mellitus (T1DM) for celiac disease antibodies and to investigate the relationship between celiac disease antibodies and lipid changes. Methods This was a cross-sectional study. A total of 98 children and adolescents with newly diagnosed T1DM were recuited for the study from March 2013 to January 2021 from a single center of the Department of Pediatric Endocrinology, Metabolism and Gastroenterology at the Affiliated Hospital of Qingdao University. We collected general data [age, sex, blood pressure, incidence of diabetic ketoacidosis (DKA), etc.] and laboratory indices [lipids (triglycerides, total cholesterol, high-density lipoprotein cholesterol, low-density lipoprotein cholesterol, lipoprotein α), glycated hemoglobin A1c(HbA1c), glutamic acid decarboxylase antibody (GADA), insulin autoantibody (IAA), etc.], and calculated body mass index standard deviation score (BMI-SDS) and atherosclerosis index. We detected total serum immunoglobin A (IgA) by scattering turbidimetric method, serum anti-tissue transglutaminase antibody-IgA (tTGA-IgA) by enzyme-linked immunosorbent assay, and endomysial antibody-IgA (EMA-IgA) by indirect immunofluorescence. Based on the tTGA-IgA and EMA-IgA test results, the subjects were divided into antibody-positive group and antibody-negative group. Two independent samplest-test, Wilcoxon test, χ2 test, or corrected χ2 test were then performed for inter-group comparison. Results Ninety-eight children and adolescents with new-onset T1DM, aged (9.38±3.56) years, had a male-to-female ratio of 1.18∶1 (53/45). There were 8 cases (8.16%) in the antibody-positive group, aged (8.07±4.12) years, with a male-to-female ratio of 3∶1 (6/2), including 2 cases positive for tTGA-IgA only, 2 cases positive for EMA-IgA only, and 4 cases positive for both tTGA-IgA and EMA-IgA. There were 90 cases (91.84%) in the antibody-negative group, aged (9.50±3.51) years, had a male-to-female ratio of 1.09∶1 (47/43). There was no significant difference between the antibody-positive and antibody-negative groups in terms of gender, age, BMI-SDS, HbA1c, the positive rates of GADA and IAA, the incidence of DKA and blood pressure (P>0.05). There was also no significant difference in triglycerides, total cholesterol, high-density lipoprotein cholesterol, low-density lipoprotein cholesterol, lipoprotein α, and atherosclerotic index between the two groups (P>0.05). Conclusions The celiac disease antibodies positive rate in children and adolescents with new-onset T1DM at our center screening was 8.16%. Although celiac disease antibodies, whether positive or negative, have no discernible impact on lipids in children and adolescents with new-onset T1DM.
Abstract
Objective To initially screen children and adolescents with new-onset type 1 diabetes mellitus (T1DM) for celiac disease antibodies and to investigate the relationship between celiac disease antibodies and lipid changes. Methods This was a cross-sectional study. A total of 98 children and adolescents with newly diagnosed T1DM were recuited for the study from March 2013 to January 2021 from a single center of the Department of Pediatric Endocrinology, Metabolism and Gastroenterology at the Affiliated Hospital of Qingdao University. We collected general data [age, sex, blood pressure, incidence of diabetic ketoacidosis (DKA), etc.] and laboratory indices [lipids (triglycerides, total cholesterol, high-density lipoprotein cholesterol, low-density lipoprotein cholesterol, lipoprotein α), glycated hemoglobin A1c(HbA1c), glutamic acid decarboxylase antibody (GADA), insulin autoantibody (IAA), etc.], and calculated body mass index standard deviation score (BMI-SDS) and atherosclerosis index. We detected total serum immunoglobin A (IgA) by scattering turbidimetric method, serum anti-tissue transglutaminase antibody-IgA (tTGA-IgA) by enzyme-linked immunosorbent assay, and endomysial antibody-IgA (EMA-IgA) by indirect immunofluorescence. Based on the tTGA-IgA and EMA-IgA test results, the subjects were divided into antibody-positive group and antibody-negative group. Two independent samplest-test, Wilcoxon test, χ2 test, or corrected χ2 test were then performed for inter-group comparison. Results Ninety-eight children and adolescents with new-onset T1DM, aged (9.38±3.56) years, had a male-to-female ratio of 1.18∶1 (53/45). There were 8 cases (8.16%) in the antibody-positive group, aged (8.07±4.12) years, with a male-to-female ratio of 3∶1 (6/2), including 2 cases positive for tTGA-IgA only, 2 cases positive for EMA-IgA only, and 4 cases positive for both tTGA-IgA and EMA-IgA. There were 90 cases (91.84%) in the antibody-negative group, aged (9.50±3.51) years, had a male-to-female ratio of 1.09∶1 (47/43). There was no significant difference between the antibody-positive and antibody-negative groups in terms of gender, age, BMI-SDS, HbA1c, the positive rates of GADA and IAA, the incidence of DKA and blood pressure (P>0.05). There was also no significant difference in triglycerides, total cholesterol, high-density lipoprotein cholesterol, low-density lipoprotein cholesterol, lipoprotein α, and atherosclerotic index between the two groups (P>0.05). Conclusions The celiac disease antibodies positive rate in children and adolescents with new-onset T1DM at our center screening was 8.16%. Although celiac disease antibodies, whether positive or negative, have no discernible impact on lipids in children and adolescents with new-onset T1DM.
关键词
糖尿病,1型/儿童/青少年/乳糜泻
Key words
Diabetes mellitus, type 1/Child/Adolescent/Celiac disease
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