新发1型糖尿病儿童青少年乳糜泻抗体的初步筛查情况及其与血脂的关系研究  

Initial screening for celiac disease antibodies in children and adolescents with new-onset type 1 diabetes mellitus and their relationship with lipids

作　　者：张珺[1] 雷珂[2] 田飞[1] 张丽娟[1] 王彩霞[1] 陈志红[1] Zhang Jun;Lei Ke;Tian Fei;Zhang Lijuan;Wang Caixia;Chen Zhihong(Department of Pediatric Endocrinology,Metabolism and Gastroenterology,Affiliated Hospital of Qingdao University,Qingdao 266000,China;Medical Research Center,Affiliated Hospital of Qingdao University,Qingdao 266000,China)

机构地区：[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

出　　处：《中华糖尿病杂志》2024年第2期207-213,共7页CHINESE JOURNAL OF DIABETES MELLITUS

基　　金：青岛市民生科技计划项目(18-6-1-72-nsh)。

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、χ^(2)检验、矫正χ^(2)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,lipoproteinα),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 samples t-test,Wilcoxon test,χ^(2) test,or correctedχ^(2) 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

关 键 词：糖尿病 1型 儿童 青少年 乳糜泻 

分 类 号：R725.8[医药卫生—儿科]