1型糖尿病酮症酸中毒患儿甲状腺激素水平变化的观察  

Changes of thyroid hormone level in type 1 diabetic children complicated with ketoacidosis

作　　者：王小军[1] 张改秀[1] 冯梅[1] 王丽红[1] 王蕾[1] 陈晓娟[1] Wang Xiaojun;Zhang Gaixiu;Feng Mei;Wang Lihong;Wang Lei;Chen Xiaojuan(Department of Endocrinology,Shanxi Children′s Hospital,Taiyuan 030013,China)

机构地区：[1]山西省儿童医院内分泌科,太原030013

出　　处：《中华全科医师杂志》2022年第2期147-153,共7页Chinese Journal of General Practitioners

基　　金：山西省儿童医院院级科研课题(202024)。

摘　　要：目的了解1型糖尿病酮症酸中毒患儿病程中甲状腺激素水平的变化。方法选取2017年12月至2020年12月山西省儿童医院内分泌科67例1型糖尿病酮症酸中毒急性期入院治疗且甲状腺激素检查结果完整[入院后急性期与恢复期(住院7~10 d后)]患儿为酸中毒组,其中男性36例、女性31例,1~<3岁4例、3~10岁38例、>10~14岁25例,轻度组(pH<7.3)22例、中度组(pH<7.2)16例、重度组(pH<7.1)29例;以44例入院时无临床合并症的1型糖尿病患儿为对照组,其中男性21例、女性23例,1~<3岁3例、3~10岁26例、>10~14岁15例。回顾性分析、比较各组入院后急性期与恢复期三碘甲状腺原氨酸(T_(3))、甲状腺素(T_(4))、游离T_(3)(FT_(3))、游离T_(4)(FT_(4))、促甲状腺激素(TSH)(甲状腺功能5项指标)水平的变化。酸中毒组急性期予均衡补液、输注胰岛素、纠酸纠酮治疗。结果甲状腺功能5项指标水平酸中毒组急性期[T_(3)0.48(0.19,0.67)nmol/L、T_(4)(49.99±26.06)nmol/L、FT_(3)1.80(1.24,2.51)pmol/L、FT_(4)9.74(7.21,12.85)pmol/L、TSH 0.86(0.31,1.81)mIU/L],明显低于对照组[T_(3)0.97(0.74,1.18)nmol/L、T_(4)(73.48±23.32)nmol/L、FT_(3)3.31(2.56,3.98)pmol/L、FT_(4)14.54(11.29,16.75)pmol/L、TSH 1.92(1.01,3.56)mIU/L],差异均有统计学意义(T_(3):Z=-5.97,T_(4):t=4.68,FT_(3):Z=-6.15,FT_(4):Z=-5.23,TSH:Z=-4.19,均P<0.001);酸中毒组恢复期[T_(3)1.58(1.25,1.86)nmol/L、T_(4)(92.52±27.03)nmol/L、FT_(3)5.03(4.15,5.78)pmol/L、FT_(4)15.94(14.40,18.38)pmol/L、TSH 2.21(1.58,3.16)mIU/L]水平较急性期显著升高,差异均有统计学意义(T_(3):Z=-6.96,T_(4):t=-11.34,FT_(3):Z=-7.00,FT_(4):Z=-6.39,TSH:Z=-5.28,均P<0.001)。酸中毒组急性期T_(3)、FT_(3)水平轻度组[0.60(0.47,0.78)nmol/L,2.20(1.47,2.89)pmol/L]、中度组[0.36(0.18,0.64)nmol/L,1.90(1.11,2.31)pmol/L]、重度组[0.35(0.16,0.54)nmol/L,1.48(1.08,1.89)pmol/L]均低于对照组(T_(3):Z=-3.44,P=0.001;Z=-3.97,P<0.001;Z=-5.63,P<0.001;FT_(3):Z=-3.44,P=0.001;Z=-4.13,P<0.001;Z=-5.86,P<0.Objective To investigate the changes of thyroid hormone level in children with type 1 diabetic mellitus(T1DM)complicated with ketoacidosis.Methods Sixty-seven children with acute T1DM and ketoacidosis admitted in Department of Endocrinology,Shanxi Children′s Hospital from December 2017 to December 2020 were enrolled as acidosis group;and 44 T1DM children without ketoacidosis at admission served as control group.According to blood gas analysis,in acidosis patients there were 22 cases in mild group(pH<7.3),16 cases in moderate group(pH<7.2)and 29 cases in severe group(pH<7.1).Serum levels of triiodothyronine(T_(3)),thyroxine(T_(4)),free T_(3)(FT_(3)),free T_(4)(FT_(4)),thyroid stimulating hormone(TSH)were measured in all patients at admission and recovery,retrospectively.Patients in the acidosis group at acute stage were treated with balanced fluid infusion,insulin infusion and eritone.Results The serum levels of T_(3)[0.48(0.19,0.67)nmol/L vs.0.97(0.74,1.18)nmol/L,Z=-5.97,P<0.001],T_(4)[(49.99±26.06)nmol/L vs.(73.48±23.32)nmol/L,t=4.68,P<0.001],FT_(3)[1.80(1.24,2.51)pmol/L vs.3.31(2.56,3.98)pmol/L,Z=-6.15,P<0.001],FT_(4)[9.74(7.21,12.85)pmol/L vs.14.54(11.29,16.75)pmol/L,Z=-5.23,P<0.001]and TSH[0.86(0.31,1.81)mIU/L vs.1.92(1.01,3.56)mIU/L,Z=-4.19,P<0.001]in acidosis group at acute stage were significantly lower than those in the control group.In acidosis group at recovery stage serum levels of T_(3)[1.58(1.25,1.86)nmol/L],T_(4)[(92.52±27.03)nmol/L],FT_(3)[5.03(4.15,5.78)pmol/L],FT_(4)[15.94(14.40,18.38)pmol/L],and TSH[2.21(1.58,3.16)mIU/L]were significantly higher than those at acute stage(Z=-6.96,t=-11.34,Z=-7.00,Z=-6.39,Z=-5.28,all P<0.001).There was an decreasing trend of T_(3) and FT_(3) levels from mild group[0.60(0.47,0.78)nmol/L,2.20(1.47,2.89)pmol/L],moderate group[0.36(0.18,0.64)nmol/L,1.90(1.11,2.31)pmol/L]to severe acidosis group[0.35(0.16,0.54)nmol/L,1.48(1.08,1.89)pmol/L](T_(3):Z=-3.44,P=0.001;Z=-3.97,P<0.001;Z=-5.63,P<0.001;FT_(3):Z=-3.44,P=0.001;Z=-4.13,P<0.001;Z=-5.86,P<0.001).Compared to cont

关 键 词：儿童 糖尿病 1型 糖尿病酮症酸中毒 甲状腺激素 

分 类 号：R725.8[医药卫生—儿科]