组织型转谷氨酰胺酶抗体对1型糖尿病患者乳糜泻的诊断价值及相关临床特点分析

Diagnostic value of tissue transglutaminase antibody and clinical characteristics analyze in type 1 diabetic patients with celiac disease

目的 评价1型糖尿病（T1DM）患者血清中组织型转谷氨酰胺酶抗体（tTGA）阳性率及乳糜泻（CD）临床症状发生率.方法 选取于南京医科大学附属逸夫医院和吉林大学第二医院门诊就诊或住院治疗的T1DM患者130例及2型糖尿病（T2DM）患者178例,病程均〈12个月.研究同时纳入109名健康成年人为对照组.采集各组研究对象的一般资料,填写CD临床症状筛查表,检测空腹血糖（FPG）、糖化血红蛋白（HbA1c）等临床指标,采用放射配体法检测血清中乳糜泻特异性抗体tTGA水平.T1DM患者根据年龄分为未成年T1DM组（年龄≤18岁）和成年T1DM组（年龄〉18岁）,比较不同年龄T1DM患者tTGA阳性率情况.此外,根据tTGA阳性与否,将T1DM组分为tTGA阳性组和tTGA阴性组,评价CD患者临床症状与tTGA的相关性.计量资料比较采用t检验或单因素方差分析,计数资料比较采用χ2检验.结果 T1DM患者tTGA阳性率显著高于T2DM患者及健康对照组（分别为19.2%比2.2%,19.2%比0.9%,χ^2=13.466、33.879,均P〈0.05）.未成年T1DM组患者tTGA阳性率显著高于成年T1DM组（26.7%比12.9%,χ^2=3.967,P〈0.05）.研究同样发现tTGA阳性组患者CD相关临床症状的发生率（≥1个CD症状和≥3个CD症状）显著高于tTGA阴性组患者（分别为64.0%比19.0%,24.0%比5.7%,χ^2=20.377、8.058,均P〈0.05）.发生率最高的三种CD相关临床症状分别为：（1）慢性腹痛、腹泻、腹胀（9/25,36.0%）;（2）体重减轻、倦怠乏力（8/25,32.0%）;（3）恶心、呕吐（6/25,24.0%）.结论 T1DM患者应进行tTGA的常规筛查,对早期诊断和预防CD有重要价值.对于存在CD典型临床症状且tTGA阳性的患者应进一步小肠黏膜活检确诊并及时给予治疗.

Objective To evaluate positive rate of serum tissue transglutaminase antibody （tTGA）, which is a specific antibody of celiac disease （CD）, and clinical symptoms of CD in patients with type 1 diabetes mellitus （T1DM）. Methods T1DM （n=130） and type 2 diabetes mellitus （T2DM） （n=178） patients with disease course less than 12 months were recruited. 109 healthy volunteers were recruited as control group. The general data of all subjects were recorded and clinical symptoms of CD collected through screening tables. Fasting plasma glucose （FPG） and HbA were measured. The levels of tTGA were detected by radioligand assay. T1DM patients were divided into juvenile T1DM group （age ≤18 years） and adult T1DM group （age〉 18 years） , and the positive rate of tTGA was analyzed in T1DM patients with different ages. In addition, T1DM patients were classified to tTGA-positive group and tTGA-negative group, and the correlation between clinical symptoms and tTGA levels were evaluated. Quantitative data were analyzed by t-test or one-way ANOVA and enumeration data were accessed by Chi-square test. Results The positive rate of tTGA in patients with T1DM was significantly higher than that in patients with T2DM and in control subjects （19.2% vs 2.2%, 19.2% vs 0.9%, respectively, X2--13.466-33.879, both P〈0.05）. The positive rate of tTGA in juvenile T1DM group was higher than that in adult T1DM group （26.7% vs 12.9%, X%3.967, P= 0.046）. The incidence of CD-related clinical symptoms （3 1 CD symptoms and≥ 3 CD symptoms） in tTGA-positive patients was significantly higher than those in tTGA-negative patients （64.0% vs 19.0%, 24.0% vs 5.7%, respectively, %20.377-8.058, both P〈0.05）. The top three highest incidence of CD-related clinical symptoms were： （1） chronic abdominal pain, diarrhea, abdominal distension （9/25, 36.0%）;（2） weight loss, fatigue （8/25, 32.0%）; （3） nausea, vomiting （6/25, 24.0%）. Conclusion TI＇GA should be routinely screened in T1DM patients and this would contribute to early prevention and diagnosis of CD. TTGA-positive patients with typical clinical symptoms of CD should be further confirmed by small intestinal mucosal biopsy and administrated treatment when necessary.