糖尿病酮症酸中毒患者甲状腺功能状态分析

Analysis of thyroid function in patients with diabetic ketoacidosis

目的分析糖尿病酮症酸中毒（DKA）患者甲状腺功能（甲功）状态。方法选择广西医科大学第九附属医院2005年11月至2013年12月住院DKA患者93例，并按性别、年龄（≤30岁组、30～60岁组、≥60岁组）、糖尿病分型（1型糖尿病、2型糖尿病）进行分组，测定各组血清FT3、FT4、促甲状腺激素（TSH）水平，并进行比较。结果甲功正常的病态综合征（ESS）发生率为79．6％（74／93），甲功正常为9．7％（9／93），甲状腺功能亢进症发生率为7．5％（7／93），亚临床甲状腺功能亢进症发生率为2．2％（2／93），甲状腺功能减退症发生率为1．1％（1／93）。男性组DKA患者的FT3水平低于女性组（t=-2．046，P=0．044），FT4、TSH比较差异无统计学意义；1型糖尿病组FT4水平低于2型糖尿病组（t=-2．352，P=0．021），但TSH高于2型糖尿病组（t=2．454，P=0．016），FT，比较差异无统计学意义（P〉0．05）。1型糖尿病组低T3／T4综合征比例高于2型糖尿病组（x^2=4．443，P=0．035）。低T3综合征比例随着年龄增加有增加的趋势（r=7．081，P=0．029）；低T3／T4综合征比例随着酸中毒严重程度的增加有增加的趋势（x^2=6．759，P=0．034）。结论DKA患者甲功异常发生率较高，甲功异常表现形式多样，ESS最常见。

Objective To investigate the thyroid function of patients with diabetic ketoacidosis （DKA）. Methods A total of 93 DKA patients admitted to the 9th Affiliated Hospital of Guangxi Medical University from November 2005 to December 2013 were selected and divided into subgroups according to age （ ≤30 years, 30-60 years, and 960 years） , gender （male, female） and type of diabetes [ （type 2 diabetes mellitus （ T2DM）, type 1 diabetes mellitus （ T1DM ） ]. FT3 , FT4 and thyroid stimulating hormone （TSH） were measured and compared among groups. Results 79.6% （74/93） of patients with DKA were found with euthyroid sick syndrome（ESS） , 9.7% （9/93） had normal thyroid function, 7.5% （7/93） had hyper- thyroidism, 2.2% （2/93） were with subclinical hyperthyroidism, and 1.1% （1/93） were diagnosed with hypothyroidism. The level of serum FT3 was lower in male group than that in female group （ t = - 2. 046, P = 0. 044） , whereas the levels of FT4 , TSH had no differences between male group and female group. Com- pared with T2DM group, T1DM group had lower FT4 level （t = -2.352, P =0.021 ） , higher TSH level （t =2. 454, P =0. 016）, and FT3 level had no difference （P 〉 0.05 ）. The proportion of low T3/T4 syn- drome in T1DM group was higher than that in T2DM group （X2 = 4. 443, P = 0. 035）. The percentage of low T3 syndrome tended to increase with age（x^2 = 7. 081, P = 0. 029） , whereas the proportion of low T3/T4 syn- drome tended to increase with the severity of ketoacidosis （x^2 = 6. 759, P = 0.034 ）. Conclusions The incidence of thyroid dysfunction in patients with DKA is high, and have various manifestations. ESS is the most common type of thyroid dysfunction.