目的:微量营养素缺乏是典型的“晚期诊断”乳糜泻(CeD)的特征。这项研究旨在确定“早期诊断”筛查确定的CeD儿童中微量营养素缺乏的患病率,以确定常规检测对这些患者缺乏的临床价值。
方法:对在大规模筛查研究中诊断出的筛查确定的CeD患者进行了病例对照研究(84例患者,平均年龄11.3±2.6岁)。控件(443个孩子,平均年龄10.8±2.5岁)乳糜泻血清学筛查阴性。血红蛋白,血清铁水平,铁蛋白,叶酸,维生素B12,维生素A,维生素E,25-OH维生素D,锌,和硒被测量。
结果:平均血清血红蛋白水平,铁,铁蛋白,维生素D,锌,铜,CeD患者的硒含量显着低于健康对照组(血红蛋白12.56vs.13.02g/dL[p=0.04];铁10.61vs.17.6μmol/L[p<0.001],铁蛋白25.7vs.48.3µg/L[p<0.001],维生素D29.1vs.37.5nmol/L,锌11.9vs.21.7μmol/L,铜18.9vs.32.5μmol/L,硒1.04vs.1.36µmol/L;p<0.001)。乳糜泻和严重肠损伤患者(MarshIIIb和IIIc)的血清铁蛋白和维生素A水平明显低于轻度肠损伤患者(MarshII和IIIa)(铁蛋白15vs.22µg/L,p<0.025;维生素A0.85vs.1.35μmol/L,p=0.007)。
结论:在“早期诊断”筛查确定的CeD病例中仍可检测到微量营养素缺乏,临床相关结果强烈支持CeD筛查和早期诊断的努力。
OBJECTIVE: Micronutrient deficiencies characterize classical \"late-diagnosed\" celiac disease (CeD). This study aimed to identify the prevalence of micronutrient deficiencies among children with \"early-diagnosed\" screening-identified CeD to determine the clinical value of routine testing for deficiencies in those patients.
METHODS: A case-control study was conducted on screening-identified CeD patients diagnosed during a mass screening study (84 patients, mean age 11.3 ± 2.6 years). The controls (443 children, mean age 10.8 ± 2.5 years) were negative for celiac disease serological screening. Hemoglobin, serum levels of iron, ferritin, folate, vitamin B12, vitamin A, vitamin E, 25-OH vitamin D, zinc, and selenium were measured.
RESULTS: The mean serum levels of hemoglobin, iron, ferritin, vitamin D, zinc, copper, and selenium were significantly lower in CeD patients than in healthy controls (hemoglobin 12.56 vs. 13.02 g/dL [p = 0.04]; iron 10.61 vs. 17.6 µmol/L [p < 0.001], ferritin 25.7 vs. 48.3 µg/L [p < 0.001], vitamin D 29.1 vs. 37.5 nmol/L, zinc 11.9 vs. 21.7 µmol/L, copper 18.9 vs. 32.5 µmol/L, selenium 1.04 vs. 1.36 µmol/L; p < 0.001). Patients with celiac and severe intestinal damage (Marsh IIIb and IIIc) had significantly lower serum ferritin and vitamin A levels than patients with mild intestinal damage (Marsh II and IIIa) (ferritin 15 vs. 22 µg/L, p < 0.025; vitamin A 0.85 vs. 1.35 µmol/L, p = 0.007).
CONCLUSIONS: Micronutrient deficiencies are still detectable in \"early-diagnosed\" screening-identified CeD cases, a clinically relevant result that strongly supports efforts for screening and early diagnosis of CeD.