目的:本研究旨在确定乳糜泻(CeD)的总患病率,包括未确诊的病例,在一项基于人群的成人CeD筛查研究中。
方法:该研究利用了第四项Trøndelag健康研究(HUNT4),在2017-2019年进行,Nord-Trøndelag县的56,042名成人(年龄>20岁)居民,挪威,参与。对54,505名参与者的血清样本进行了抗谷氨酰胺转氨酶2免疫球蛋白A和G的分析。包括十二指肠活检的上消化道内窥镜检查。通过与医院记录和挪威患者登记处的联系,确定了先前诊断和血清阴性的CeD病例。
结果:CeD血清阳性率为2.0%(1107/54,505)。在这些中,724人参加了临床评估。此外,医院记录和登记处确定了已知CeD诊断的个体,HUNT4血清阴性或无血清学或HUNT4血清阳性,但未参与临床评估。总的来说,本研究在470名个体参与HUNT4后证实了一项新的CeD诊断,在383名个体参与HUNT4前证实了一项已知的CeD诊断.经活检证实的CeD的总患病率为1.5%(853/56,042),和新的比率,以前未诊断的CeD病例(HUNT4后)已知,先前诊断的CeD病例(HUNT4之前)为1.2:1(470/383)。
结论:在这项基于人群的挪威成年人研究中,CeD的总患病率很高,许多人以前未被诊断。应改进CeD的检测,早期诊断对于有效治疗和预防并发症至关重要。
OBJECTIVE: This study aimed to determine the total prevalence of celiac disease (CeD), including undiagnosed cases, in a population-based study of adults screened for CeD.
METHODS: The study used the fourth Trøndelag Health Study (HUNT4), conducted in 2017-2019, where 56,042 adult (aged >20 years) residents of Nord-Trøndelag County, Norway, participated. Serum samples from 54,505 participants were analyzed for anti-transglutaminase 2 IgA and IgG. Seropositive individuals were invited for a clinical assessment, including upper endoscopy with duodenal biopsies. Previously diagnosed and seronegative CeD cases were identified through linkage to hospital records and the Norwegian Patient Registry.
RESULTS: The rate of CeD seropositivity was 2.0% (1107/54,505). Out of these, 724 individuals attended the clinical assessment. Additionally, the hospital records and registry identified individuals with a known CeD diagnosis, that were seronegative or without serology in HUNT4 or seropositive in HUNT4 but did not participate in the clinical assessment. In total, the study confirmed a new CeD diagnosis after participation in HUNT4 in 470 individuals and a known CeD diagnosis before participation in HUNT4 in 383 individuals. The total biopsy-confirmed prevalence of CeD was 1.5% (853/56,042), and the ratio of new, previously undiagnosed CeD cases (after HUNT4) to known, previously diagnosed CeD cases (before HUNT4) was 1.2:1 (470/383).
CONCLUSIONS: The total prevalence of CeD in this population-based study of adults in Norway was high and many individuals were previously undiagnosed. Detection of CeD should be improved, because early diagnosis is crucial for effective management and prevention of complications.