这项随机研究纳入了832例有一个直系亲属患乳糜泻的新生儿作为受试者，分别从6个月或12个月时添加服用谷蛋白。36周时，研究仍留有707名受试者，其中有553名为HLA标危型和高危型。在2周岁时，6个月组患自身免疫性乳糜泻的新生儿比12个月组显著增多(16% vs 7%; P = 0.002)，明显乳糜泻的患儿比例也明显增多(12% vs 5%; P = 0.01)。然而，这些差异在受试者5周岁时不再显著。与标危型HLA受试者相比，高危型HLA 受试者在10周岁时患自身免疫性乳糜泻(38% vs 19%; P = 0.01)和明显乳糜泻(26% vs 16%; P =0 .05)风险较高。
This study randomly assigned 832 newborns with a first-degree relative with celiac disease to be introduced to gluten at 6 months or 12 months. At 36 months, 707 participants remained in the trial, of which 553 had standard-risk or high-risk HLA genotype. At age 2 years, significantly more children introduced to gluten at 6 months vs 12 months had celiac disease autoimmunity (16% vs 7%; P = .002) and overt celiac disease (12% vs 5%; P = .01). However, these differences did not remain significant at 5 years of age. In children with high-risk vs standard-risk HLA, the risks for celiac disease autoimmunity (38% vs 19%; P = .01) and overt celiac disease (26% vs 16%; P = .05) were higher at 10 years of age.
The authors conclude that delaying introduction of gluten does not modify the risk for celiac disease in at-risk children, although it may be associated with a delayed onset of disease.
The New England Journal of Medicine
Introduction of Gluten, HLA Status, and the Risk of Celiac Disease in Children
N. Engl. J. Med 2014 Oct 02;371(14)1295-1303, E Lionetti, S Castellaneta, R Francavilla, A Pulvirenti, E Tonutti, S Amarri, M Barbato, C Barbera, G Barera, A Bellantoni, E Castellano, G Guariso, MG Limongelli, S Pellegrino, C Polloni, C Ughi, G Zuin, A Fasano, C Catassi
This abstract is available on the publisher's site.
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