非甲状腺疾病综合征在初发1型糖尿病患儿中的发生率及相关因素分析  

The incidence of non-thyroidal illness syndrome in children with type 1 diabetes mellitus and correlated factors analysis

作　　者：蒋明玉 尹小琴 李嫔[1] Jiang Mingyu;Yin Xiaoqin;Li Pin(Department of Endocrinology and Genetic Metabolism,Children′s Hospital of Shanghai Jiao Tong University,Shanghai 200062,China)

机构地区：[1]上海交通大学附属儿童医院内分泌遗传代谢科,上海200062

出　　处：《中华实用儿科临床杂志》2022年第6期434-438,共5页Chinese Journal of Applied Clinical Pediatrics

基　　金：国家自然科学基金(81871131);上海市卫计委卫生系统重要薄弱学科建设(2016ZB0102)。

摘　　要：目的研究初发1型糖尿病(T1DM)患儿中非甲状腺疾病综合征(NTIS)的发生率及相关因素,分析三碘甲状腺原氨酸与T1DM严重程度的相关性,为临床诊治提供依据。方法对2015年1月至2019年12月上海交通大学附属儿童医院内分泌遗传代谢科收治的125例初发T1DM的患儿资料进行回顾性分析,统计其中NTIS的发病率。采用两独立样本t检验比较T1DM患儿中甲状腺功能正常组和NTIS组在多个因素方面的差异,并采用Spearman相关分析进一步分析游离三碘甲状腺原氨酸(FT3)、总三碘甲状腺原氨酸(TT3)水平与儿童初发T1DM严重程度的相关性。结果125例初发T1DM的患儿中,NTIS发生率为26.4%(33/125例)。NTIS组患儿的FT3、TT3、总四碘甲状腺原氨酸(TT4)、促甲状腺激素(TSH)、pH值、HCO_(3)^(-)、高密度脂蛋白胆固醇(HDL-C)水平均显著低于甲状腺功能正常组[(3.10±0.45)pmol/L比(4.85±0.75)pmol/L、(0.60±0.28)nmol/L比(1.05±0.38)nmol/L、(65.77±23.41)nmol/L比(89.57±18.23)nmol/L、(0.91±0.89)mIU/L比(2.05±0.76)mIU/L、7.21±0.17比7.31±0.18、(11.49±7.54)mmol/L比(16.80±8.38)mmol/L、(1.08±0.49)mmol/L比(1.28±0.44)mmol/L],而阴离子间隙(AG)、入院血糖(BG)、三酰甘油均显著高于甲状腺功能正常组[(22.53±8.33)mmol/L比(16.94±7.52)mmol/L、(24.85±4.71)mmol/L比(21.46±6.64)mmol/L、(2.72±2.05)mmol/L比(2.33±3.05)mmol/L],差异均有统计学意义(t=4.56、5.67、4.48、5.61、2.82、2.68、2.53、3.22、2.67、2.04,均P<0.05)。甲状腺功能正常组、NTIS组及甲状腺疾病所致异常组的糖尿病酮症酸中毒(DKA)发生率(33.3%比63.6%比35.7%)差异有统计学意义(χ^(2)=8.990,P<0.05)。相关性分析显示,T1DM患儿血清FT3水平与pH值、HCO_(3)^(-)呈正相关,与AG呈负相关(r=0.3769、0.4397、-0.4119,均P<0.05);TT3水平与pH值、HCO_(3)^(-)呈正相关,与AG、BG呈负相关(r=0.5132、0.5398、-0.4824、-0.2115,均P<0.05)。结论T1DM患儿可伴甲状腺激素水平异常,其中NTIS的发生Objective To explore the incidence of non-thyroidal illness syndrome(NTIS)in children with type 1 diabetes mellitus(T1DM)and the correlation between triiodothyronine level and the severity of T1DM,thus providing evidence for clinical diagnosis and treatment.Methods A total of 125 children initially diagnosed as T1DM at the Department of Endocrinology and Genetic Metabolism of Children′s Hospital of Shanghai Jiao Tong University from January 2015 to December 2019 were recruited.The data were retrospectively analyzed.The incidence of NTIS in T1DM children was explored.T1DM children were classified into euthyroid group and NTIS group,two independent sample t-test were used to compare the differences in multiple factors between euthyroid group and NTIS group in children with T1DM,and Spearman correlation analysis was used to further analyze the correlation between the levels of free triiodothyronine(FT3),total triiodothyronine(TT3)and the severity of children with primary T1DM.Results The incidence of NTIS in 125 T1DM children was 26.4%(33/125 cases).FT3,TT3,total thyroxine(TT4),thyrotropin(TSH),pH value,HCO_(3)^(-)and high density lipoprotein cholesterol(HDL-C)levels in NTIS group were significantly lower than those of euthyroid group[(3.10±0.45)pmol/L vs.(4.85±0.75)pmol/L,(0.60±0.28)nmol/L vs.(1.05±0.38)nmol/L,(65.77±23.41)nmol/L vs.(89.57±18.23)nmol/L,(0.91±0.89)mIU/L vs.(2.05±0.76)mIU/L,7.21±0.17 vs.7.31±0.18,(11.49±7.54)mmol/L vs.(16.80±8.38)mmol/L,(1.08±0.49)mmol/L vs.(1.28±0.44)mmol/L](t=4.56,5.67,4.48,5.61,2.82,2.68,and 2.53,all P<0.05).Moreover,the anion gap(AG)level,blood glucose(BG)and triglyceride in NTIS group were significantly higher than those of euthyroid group[(22.53±8.33)mmol/L vs.(16.94±7.52)mmol/L,(24.85±4.71)mmol/L vs.(21.46±6.64)mmol/L,(2.72±2.05)mmol/L vs.(2.33±3.05)mmol/L](t=3.22,2.67 and 2.04,all P<0.05).The incidence of diabetic ketoacidosis(DKA)was statistically significant in euthyroid group,NTIS group and abnormal thyroid disease group(33.3%vs.63.6%vs.35.7%)(χ^(2)=

关 键 词：非甲状腺疾病综合征 1型糖尿病 酮症酸中毒 儿童 

分 类 号：R725.8[医药卫生—儿科]