1型糖尿病并低三碘甲状腺氨酸综合征201例

Clinical Analysis of 201 Children with Type 1 Diabetes Mellitus Complicated with Low Triiodothyronine Syndrome

目的探讨1型糖尿病(T1DM)及糖尿病酮症酸中毒(DKA)患儿并低三碘甲状腺氨酸(T3)综合征的临床特点。方法采用放射免疫分析法检测91例T1DM并DKA患儿(DKA组)及110例单纯T1DM患儿(非DKA组)血清T3、甲状腺素(T4)、促甲状腺激素(TSH)水平,观察2组T3、T4下降例数及水平,并将DKA组分为轻、中、重3个亚组,观察不同组别中甲状腺激素变化特点。结果 DKA组易发生T3、T4下降,DKA组T3[(0.54±0.51)μg.L-1]、T4[(5.65±2.80)μg.L-1]与非DKA组T3[(1.02±0.38)μg.L-1]、T4[(9.28±2.85)μg.L-1]比较,差异均有统计学意义(Pa<0.000 1)。中、重度DKA组与非DKA组T3比较,差异有统计学意义(Pa<0.000 1),轻、中、重度DKA组与非DKA组T4比较,差异均有统计学意义(Pa<0.000 4,0.000 1)。DKA组与非DKA组TSH比较,差异无统计学意义(P>0.05)。结论 T1DM患儿甲状腺激素检测的结果主要表现为T3降低,部分伴T4降低,其疾病的严重程度与甲状腺激素降低程度一致,T1DM并DKA患儿的T3、T4水平均有明显下降,提示T1DM患儿需重视甲状腺激素的检测,利于早期防治。

Objective To explore clinical characters in the children with type 1 diabetes mellitus（T1DM） and diabetic acidosis（DKA） complicated with low triiodothyronine（T3） syndrome. Methods Ninety-one patients complicated with DKA and 110 patients with T1DM without DKA were reviewed.Radioimmunoassay was used to examine the serum levels of free tetraiodothyronine（T4）,and free T3 and thyroid-stimulating hormone（TSH）.Decreased levels of T3 and T4 were observed,as well as the number of patients with decreased T3 and T4.Patients with DKA were further divided into 3 groups：the mild group,the medial group and the severe group.The characteristics of variations in thyroid hormone in patients of different groups were investigated. Results T3 and T4 levels were prone to decrease in DKA group.T3 level was（0.54±0.51） μg·L-1 and T4 level was（5.65± 2.80） μg·L-1 in DKA group,T3 level was（1.02±0.38） μg·L-1 and T4 level was（9.28±2.85） μg·L-1 in non-DKA group.The serum levels of T3 and T4 in DKA group were significantly lower than those in the non-DKA group（Pa0.000 1）.Serum T3 levels in the patients from the medial group and the severe group were significantly lower than that in the non-DKA group（Pa0.000 1）.Serum T4 levels in patients from the mild,the medial and severe group were significantly lower than that in the non-DKA group（P0.000 4,0.000 1）.There was no difference between the TSH levels in DKA groups and non-DKA group（P0.05）. Conclusions T3 level decreases in patients of T1DM,whereas T4 level decreases rarely.The severity of diabetes shows a correspondence to the decreased serum levels of T3,T4.T1DM patients complicated with DKA show a significant decrease in T3,T4 levels,which suggests that more attention should be paid to the thyroid function of T1DM patients,and this will be beneficial for early stage control of T1DM complications.