流行病学
在美国和欧洲,乳糜泻是常见疾病。根据一些设计精良的研究,许多国家/地区已发现相对一致的患病率,总体的全球血清阳性率和活检证实的患病率分别为 1.4% 和 0.7%。[1]Singh P, Arora A, Strand TA, et al. Global prevalence of celiac disease: systematic review and meta-analysis. Clin Gastroenterol Hepatol. 2018 Jun;16(6):823-36.http://www.ncbi.nlm.nih.gov/pubmed/29551598?tool=bestpractice.com[2]Sood A, Midha V, Sood N, et al. Prevalence of celiac disease among school children in Punjab, North India. J Gastroenterol Hepatol. 2006 Oct;21(10):1622-5.http://www.ncbi.nlm.nih.gov/pubmed/16928227?tool=bestpractice.com[3]Ertekin V, Selimoglu MA, Kardas F, et al. Prevalence of celiac disease in Turkish children. J Clin Gastroenterol. 2005 Sep;39(8):689-91.http://www.ncbi.nlm.nih.gov/pubmed/16082278?tool=bestpractice.com[4]Yap TW, Chan WK, Leow AH, et al. Prevalence of serum celiac antibodies in a multiracial Asian population: a first study in the young Asian adult population of Malaysia. PLoS One. 2015 Mar 23;10(3):e0121908.https://journals.plos.org/plosone/article?id=10.1371/journal.pone.0121908http://www.ncbi.nlm.nih.gov/pubmed/25799401?tool=bestpractice.com[5]Ashtari S, Najafimehr H, Pourhoseingholi MA, et al. Prevalence of celiac disease in low and high risk population in Asia-Pacific region: a systematic review and meta-analysis. Sci Rep. 2021 Jan 27;11(1):2383.https://www.ncbi.nlm.nih.gov/pmc/articles/pmid/33504878/http://www.ncbi.nlm.nih.gov/pubmed/33504878?tool=bestpractice.com[6]Makharia GK, Chauhan A, Singh P, et al. Review article: Epidemiology of coeliac disease. Aliment Pharmacol Ther. 2022 Jul;56 Suppl 1:S3-17.http://www.ncbi.nlm.nih.gov/pubmed/35815830?tool=bestpractice.com虽然全球血清阳性率相近,但在南美洲、中东、土耳其和撒哈拉以南非洲地区,经活检确诊的乳糜泻病例略为少见,在中国和日本则更加罕见。[1]Singh P, Arora A, Strand TA, et al. Global prevalence of celiac disease: systematic review and meta-analysis. Clin Gastroenterol Hepatol. 2018 Jun;16(6):823-36.http://www.ncbi.nlm.nih.gov/pubmed/29551598?tool=bestpractice.com[5]Ashtari S, Najafimehr H, Pourhoseingholi MA, et al. Prevalence of celiac disease in low and high risk population in Asia-Pacific region: a systematic review and meta-analysis. Sci Rep. 2021 Jan 27;11(1):2383.https://www.ncbi.nlm.nih.gov/pmc/articles/pmid/33504878/http://www.ncbi.nlm.nih.gov/pubmed/33504878?tool=bestpractice.com[7]Singh P, Arora S, Singh A, et al. Prevalence of celiac disease in Asia: a systematic review and meta-analysis. J Gastroenterol Hepatol. 2016 Jun;31(6):1095-101.http://www.ncbi.nlm.nih.gov/pubmed/26678020?tool=bestpractice.com澳大利亚、新西兰、以色列和印度的血清阳性率和乳糜泻活检确诊率与欧洲和北美国家相当。[7]Singh P, Arora S, Singh A, et al. Prevalence of celiac disease in Asia: a systematic review and meta-analysis. J Gastroenterol Hepatol. 2016 Jun;31(6):1095-101.http://www.ncbi.nlm.nih.gov/pubmed/26678020?tool=bestpractice.com在欧洲(尤其是北欧),小儿乳糜泻的发病率和患病率日益增长。[8]Roberts SE, Morrison-Rees S, Thapar N, et al. Systematic review and meta-analysis: the incidence and prevalence of paediatric coeliac disease across Europe. Aliment Pharmacol Ther. 2021 Jul;54(2):109-28.http://www.ncbi.nlm.nih.gov/pubmed/34115894?tool=bestpractice.com[9]King JA, Jeong J, Underwood FE, et al. Incidence of celiac disease is increasing over time: a systematic review and meta-analysis. Am J Gastroenterol. 2020 Apr;115(4):507-25.http://www.ncbi.nlm.nih.gov/pubmed/32022718?tool=bestpractice.com美国的发病率可能也在增长;科罗拉多州丹佛市儿童的筛查研究发现,15 岁以下儿童的乳糜泻累积发病率估计为 3.1%。[10]Liu E, Dong F, Barón AE, et al. High incidence of celiac disease in a long-term study of adolescents with susceptibility genotypes. Gastroenterology. 2017 May;152(6):1329-36.e1.https://www.ncbi.nlm.nih.gov/pmc/articles/pmid/28188747/http://www.ncbi.nlm.nih.gov/pubmed/28188747?tool=bestpractice.com
女性略微更易患乳糜泻。[1]Singh P, Arora A, Strand TA, et al. Global prevalence of celiac disease: systematic review and meta-analysis. Clin Gastroenterol Hepatol. 2018 Jun;16(6):823-36.http://www.ncbi.nlm.nih.gov/pubmed/29551598?tool=bestpractice.com[11]Jansson-Knodell CL, Hujoel IA, West CP, et al. Sex difference in celiac disease in undiagnosed populations: a systematic review and meta-analysis. Clin Gastroenterol Hepatol. 2019 Sep;17(10):1954-68.e13.http://www.ncbi.nlm.nih.gov/pubmed/30448593?tool=bestpractice.com 尽管在美国诊断时最常见的年龄大约为 40 岁,但乳糜泻可能在任何年龄被诊断。[12]Green PH. The many faces of celiac disease: clinical presentation of celiac disease in the adult population. Gastroenterology. 2005 Apr;128(4 Suppl 1):S74-8.http://www.ncbi.nlm.nih.gov/pubmed/15825130?tool=bestpractice.com[13]Green PH, Stavropoulos SN, Panagi SG, et al. Characteristics of adult celiac disease in the USA: results of a national survey. Am J Gastroenterol. 2001 Jan;96(1):126-31.http://www.ncbi.nlm.nih.gov/pubmed/11197241?tool=bestpractice.com
一般认为,无症状乳糜泻患者至少占乳糜泻患者的 20%,而难治性乳糜泻患者占乳糜泻患者的不到 1%。[14]Ilus T, Kaukinen K, Virta LJ, et al. Refractory coeliac disease in a country with a high prevalence of clinically-diagnosed coeliac disease. Aliment Pharmacol Ther. 2014 Feb;39(4):418-25.https://onlinelibrary.wiley.com/doi/10.1111/apt.12606http://www.ncbi.nlm.nih.gov/pubmed/24387637?tool=bestpractice.com
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