成人与儿童1型糖尿病甲状腺自身免疫性相关性的研究

Screening for thyroid autoimmunity in adults and pediatrics with type 1 diabetes

目的:研究1型糖尿病(type 1 diabetes,T1D)患者甲状腺自身免疫抗体与胰岛自身抗体及甲状腺功能的关系、成人与儿童患者甲状腺自身免疫性的差异。方法:对491例T1D患者进行临床资料的收集及甲状腺功能、甲状腺及胰岛自身抗体的检测。结果:22.0%的T1D患者合并甲状腺自身抗体(T-Ab)阳性(女性占62%);T-Ab阳性患者其胰岛自身抗体阳性率均较T-Ab阴性者高(P均<0.05);甲状腺过氧化物酶抗体(TPOAb)阳性率与5种胰岛自身抗体阳性率均成正相关(P<0.05),而甲状腺球蛋白抗体(TGAb)仅与谷氨酸脱羧酶抗体(GADA)相关(P=0.005);多胰岛自身抗体阳性患者T-Ab阳性率显著高于单个胰岛自身抗体阳性及T-Ab阴性者(30.2%,P=0.000);成人T1D患者22.6%出现T-Ab,其中TGAb及TPOAb均阳性的患者较儿童多(双甲状腺抗体阳性:57.8%vs 36.4%,P=0.028);TPOAb与TGAb均阳性的患者血清促甲状腺素(TSH)水平较高(P=0.008),其发生甲状腺功能异常风险高(甲状腺功能异常:64.2%vs 30.9%,P=0.002)。结论:成人及儿童T1D均易合并出现甲状腺抗体阳性,其中女性、GADA阳性、多胰岛自身抗体阳性者自身免疫性甲状腺疾病(AITD)发病风险更高;成人患者AITD发病风险与儿童无明显差异,但甲状腺自身免疫程度更剧烈;合并多甲状腺自身抗体阳性的患者更易出现甲状腺功能异常,需密切跟踪随访。

Objective:The aim of this study was to investigate in patients with type 1 diabetes(T1D):the prevalence of thyroid autoantibodies(T-Ab);the association between thyroid autoimmunity with either islet autoantibodies or thyroid function;and the differences of thyroid autoimmunity between adults and pediatrics. Methods:A total of 491 T1 D patients were analyzed for thyroid autoimmunity in addition to islet autoantibodies and thyroid function. Results:Tweenty-two percentage T1 D patients had thyroid autoantibodies(62% were female). Patients with T-Ab had higher prevalence of islet autoantibodies(all P <0.05). While thyroid peroxidase(TPOAb) was positively associated with all the 5 islet autoantibodies(all P < 0.05),thyroglobulin(TGAb) was only associated with glutamic acid decarboxylase antibody(GADA,P=0.005). In addition,the positive number of islet autoantibodies was positively associated with the prevalence of T-Ab(30.2%,P=0.000). Tweenty-two point six percentage adults with T1 D had T-Ab,adults with double anti-thyroid autoantibodies positivity was more than that in the pediatric group(prevalence of double T-Abs:57.8% vs 36.4%,P=0.028). The presence of T-Ab was positively associated with serum thyroid-stimulating hormone(TSH) levels(P=0.008). The presence of both anti-thyroid antibodies was positively associated with thyroid dysfunction(prevalence of thyroid dysfunction:64.2% vs 30.9%,P =0.002). Conclusion:Thyroid autoimmunity was commonly happened in adults and pediatrics with T1 D. Thyroid autoimmunity was associated with female gender,the persistence of GADA and multiple islet autoantibodies positivity. The risk of thyroid autoimmunity did not differ from adults to pediatrics;however,the thyroid au-toimmunity was severe in the adults. Multiple anti-thyroid autoantibodies indicated thyroid dysfunction.