初发1型糖尿病儿童甲状腺激素、氧化应激指标检测及临床意义

Detection of thyroid hormone and oxidative stress in children with new-onset type 1 diabetes mellitus and its clinical significance

目的探讨甲状腺激素、氧化应激指标水平检测对初发1型糖尿病儿童的临床意义。方法选择2016年4月至2019年4月西安市儿童医院接诊的174例1型糖尿病患儿为研究组,根据其病程分为研究A组(初发,145例)和研究B组(病程稍长,29例),并选取同期87例健康儿童为对照组。比较各组受检者血清中甲状腺激素水平[包括四碘甲腺原氨酸(T4)、三碘甲腺原氨酸(T3)、游离四碘甲腺原氨酸(FT4)、游离三碘甲腺原氨酸(FT3)、促甲状腺激素(TSH)和反三碘甲状腺原氨酸(rT3)]以及血清中氧化应激指标水平[包括氧化标志物丙二醛(MDA)、一氧化氮(NO)、超氧化物歧化酶(SOD)、谷胱甘肽过氧化物酶(GSH-Px)]。结果研究组患儿血清T3、FT3、FT4水平分别为(1.20±0.30)nmol/L、(3.97±2.04)pmol/L、(11.07±6.73)pmol/L,明显低于对照组的(1.51±0.30)nmol/L、(6.20±1.62)pmol/L、(15.77±5.50)pmol/L,rT3水平为(0.88±0.61)nmol/L,明显高于对照组的(0.49±0.31)nmol/L,差异均有统计学意义(P<0.05),而以上两组患儿的血清T4、TSH水平比较差异均无统计学意义(P>0.05);研究B组患儿血清T3、FT3、FT4水平分别为(1.16±0.28)nmol/L、(3.86±2.00)pmol/L、(11.01±7.12)pmol/L,明显低于研究A组的(1.24±0.31)nmol/L、(4.07±2.09)pmol/L、(11.24±6.31)pmol/L,rT3水平为(0.90±0.65)nmol/L,明显高于研究A组的(0.86±0.57)nmol/L,差异均有统计学意义(P<0.05);研究组患儿血清MDA、NO、SOD水平分别为(11.97±5.01)nmol/L、(54.59±19.47)nmol/L、(114.40±22.00)U/mL,明显高于对照组的(6.49±3.60)nmol/L、(30.02±15.67)nmol/L、(103.72±20.51)U/mL,GSH-Px水平为(99.36±32.24)U/L,明显低于对照组的(138.13±38.06)U/L,差异均有统计学意义(P<0.05);研究A组患儿血清MDA、NO、SOD水平分别为(11.54±4.82)nmol/L、(54.98±20.07)nmol/L、(114.77±22.62)U/mL,明显高于对照组,GSH-Px水平为(98.02±33.27)U/L,明显低于对照组,差异均有统计学意义(P<0.05);研究B组患儿血清MDA、NO水平分别为(12.71±6.42)nmol/L、(53.38±15.01)nmol/L,明显高于对照组,GSH-Px水平为(101.03±24.89)U/L,明显低于对照组,差异均有统计学意义(P<0.05);研究B组患儿的SOD水平与对照组比较差异无统计学意义(P>0.05)。结论初发1型糖尿病儿童T3、FT3、T4等甲状腺激素水平下降,rT3水平上升;MDA、NO、SOD等氧化应激指标水平上升,GSH-Px水平下降。甲状腺激素及氧化应激指标检测可以有效评估初发1型糖尿病患儿病情程度,临床诊断价值高,对患儿后期治疗及预后具有较大临床意义。

Objective To investigate the clinical significance of thyroid hormone and oxidative stress levels in children with newly diagnosed type 1 diabetes.Methods A total of 174 children with type 1 diabetes,who admitted to Xi'an Children's Hospital from April 2016 to April 2019 were selected and divided into the study group A(newly diagnosed,145 cases)and study group B(slightly longer,29 cases)according to their disease course.At the same time,87 healthy children were selected as the control group.The serum levels of thyroid hormones(tetraiodothyronine[T4],triiodothyronine[T3],free tetraiodothyronine[FT4],free three Iodothyronine[FT3],thyroid stimulating hormone[TSH],anti-triiodothyronine[rT3])and oxidative stress markers(malondialdehyde[MDA],nitric oxide[NO],superoxide dismutase[SOD],and glutathione peroxidase[GSH-Px])in each groups were observed and compared.Results The levels of serum T3,FT3 and FT4 in the study group were(1.20±0.30)nmol/L,(3.97±2.04)pmol/L,(11.07±6.73)pmol/L,respectively,which were significantly lower than corresponding(1.51±0.30)nmol/L,(6.20±1.62)pmol/L,(15.77±5.50)pmol/L of the control group(all P<0.05);rT3 level was(0.88±0.61)nmol/L,which was significantly higher than(0.49±0.31)nmol/L of the control group(P<0.05);but there were no significant difference in serum T4 and TSH levels between the two groups(all P>0.05).The levels of serum T3,FT3 and FT4 in the group B were(1.16±0.28)nmol/L,(3.86±2.00)pmol/L,(11.01±7.12)pmol/L,respectively,which were significantly lower than corresponding(1.24±0.31)nmol/L,(4.07±2.09)pmol/L,(11.24±6.31)pmol/L of group A(all P<0.05);rT3 level was(0.90±0.65)nmol/L,which was significantly higher than(0.86±0.57)nmol/L of the study group A(P<0.05);the levels of serum MDA,NO and SOD in the study group were(11.97±5.01)nmol/L,(54.59±19.47)nmol/L,(114.40±22.00)U/mL,respectively,which were significantly higher than corresponding(6.49±3.60)nmol/L,(30.02±15.67)nmol/L,(103.72±20.51)U/mL of the control group(all P<0.05);GSH-Px level was(99.36±32.24)U/L,which was significantly lower than(138.13±38.06)U/L of the control group(P<0.05);the levels of serum MDA,NO and SOD in the study group A were(11.54±4.82)nmol/L,(54.98±20.07)nmol/L,(114.77±22.62)U/mL,respectively,which were significantly higher than those of the control group(all P<0.05);GSH-Px level was(98.02±33.27)U/L,which was significantly lower than that of the control group(P<0.05);the serum MDA and NO levels in the study group B were(12.71±6.42)nmol/L,(53.38±15.01)nmol/L,respectively,which were significantly higher than those of the control group(all P<0.05);GSH-Px level was(101.03±24.89)U/L,which was significantly lower than that of the control group(P<0.05);there was no significant difference in the SOD level between the study group B and the control group(P>0.05).Conclusion The levels of thyroid hormones such as T3,FT3 and T4 in children with new-onset type 1 diabetes decreased,and the level of rT3 increased;the levels of oxidative stress such as MDA,NO and SOD increased,and the level of GSH-Px decreased.The detection of thyroid hormone and oxidative stress index can effectively be used to evaluate the degree of disease in children with new-onset type 1 diabetes,and has high clinical diagnostic value,it has great clinical significance for the treatment and prognosis of children.