Parameters associated with the development of autoimmune diseases in pediatric onset celiac disease.

IF 2.6 3区医学 Q1 PEDIATRICS European Journal of Pediatrics Pub Date : 2025-02-13 DOI:10.1007/s00431-025-06028-5

Firas Abu Hanna, Maia Sirkin, Bar Sofer Ilovich, Ranya Egbarieh, Sameh Tatour, Avishay Lahad, Sarit Peleg, Tal Almagor, Firas Rinawi

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Abstract

Patients with celiac disease (CeD) have an increased risk of developing other autoimmune diseases (ADs); however, risk factors and predictors for ADs remain unclear. The study objective is to assess predictors for development of ADs among pediatric onset CeD patients. The study included pediatric onset CeD patients, evaluated at Emek Medical Center, and followed for at least 2 years from April 2008 to April 2022. Data were collected from medical records and included baseline and follow-up data of demographics, clinical manifestations, laboratory variables, and subsequent development of ADs. Then, 930 children with CeD were included, and 790 fulfilled inclusion criteria. Patients were followed for a median of 4.9 years (range 2-16 years). During follow-up, 45%, 68%, and 80% normalized their tissue transglutaminase (TTG) levels by 6, 12, and 24 months, respectively. Among the entire cohort, 16 patients (2%) developed type 1 diabetes mellitus, 35 (4.4%) developed Hashimoto's thyroiditis, and 11 (1.3%) developed other ADs. Of 510 patients with sustained serological remission, 39 (7.6%) patients developed ADs compared to 23 (11.5%) of patients without sustained serological remission. In multivariate Cox models, shorter time to TTG normalization (hazard ratio (HR) 0.94 CI 95% 0.88-0.99) and sustained TTG levels less than three times the upper limit of normal (HR 0.87 CI 95% 0.72-0.96) were significantly associated with reduced risk of developing ADs.

Conclusion: Effective management of celiac disease, including timely TTG normalization and sustained lower TTG levels, may be important for reducing the risk of subsequent development of ADs in pediatric-onset CeD.

What is known: • Pediatric patients with celiac disease (CeD) are at an increased risk of developing autoimmune diseases (ADs). Risk factors contributing to the development of ADs in CeD patients are not well established, particularly in the pediatric population.

What is new: • Timely TTG normalization and sustained low TTG levels (<3 times ULN) during follow-up are associated with a reduced risk of developing additional ADs in pediatric CeD patients.

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与儿童发病乳糜泻自身免疫性疾病发展相关的参数

乳糜泻（CeD）患者发生其他自身免疫性疾病（ADs）的风险增加；然而，ad的风险因素和预测因素仍不清楚。本研究的目的是评估儿科发病的CeD患者发生ad的预测因素。该研究纳入了在Emek医学中心评估的儿科发病的CeD患者，并从2008年4月至2022年4月进行了至少2年的随访。数据收集自医疗记录，包括人口统计学、临床表现、实验室变量和ad的后续发展的基线和随访数据。然后纳入930名CeD儿童，其中790名符合纳入标准。患者随访时间中位数为4.9年（范围2-16年）。在随访期间，45%、68%和80%的患者分别在6个月、12个月和24个月后组织转谷氨酰胺酶（TTG）水平恢复正常。在整个队列中，16名患者（2%）发展为1型糖尿病，35名（4.4%）发展为桥本甲状腺炎，11名（1.3%）发展为其他ad。在510名持续血清学缓解的患者中，39名（7.6%）患者发展为ad，而未持续血清学缓解的患者中有23名（11.5%）患者发展为ad。在多变量Cox模型中，较短的TTG正常化时间（风险比（HR） 0.94 CI 95% 0.88-0.99）和持续的TTG水平低于正常上限的3倍（HR 0.87 CI 95% 0.72-0.96）与发生ad的风险降低显著相关。结论：有效的乳糜泻管理，包括及时的TTG正常化和持续较低的TTG水平，可能对降低儿科发病的CeD随后发生ad的风险很重要。已知情况：•患有乳糜泻（CeD）的儿科患者发生自身免疫性疾病（ADs）的风险增加。导致CeD患者发生ad的危险因素尚不清楚，特别是在儿科人群中。•及时TTG正常化和持续低TTG水平(

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来源期刊

European Journal of Pediatrics 医学-小儿科

CiteScore

5.90

自引率

2.80%

发文量

367

审稿时长

3-6 weeks

期刊介绍： The European Journal of Pediatrics (EJPE) is a leading peer-reviewed medical journal which covers the entire field of pediatrics. The editors encourage authors to submit original articles, reviews, short communications, and correspondence on all relevant themes and topics. EJPE is particularly committed to the publication of articles on important new clinical research that will have an immediate impact on clinical pediatric practice. The editorial office very much welcomes ideas for publications, whether individual articles or article series, that fit this goal and is always willing to address inquiries from authors regarding potential submissions. Invited review articles on clinical pediatrics that provide comprehensive coverage of a subject of importance are also regularly commissioned. The short publication time reflects both the commitment of the editors and publishers and their passion for new developments in the field of pediatrics. EJPE is active on social media (@EurJPediatrics) and we invite you to participate. EJPE is the official journal of the European Academy of Paediatrics (EAP) and publishes guidelines and statements in cooperation with the EAP.