儿童初发1型糖尿病伴不同程度糖尿病酮症酸中毒与甲状腺功能相关性研究

doi:10.12372/jcp.2022.21e1315

Abstract

Abstract:

Objective To explore the correlation between serum thyroid hormone and diabetic ketoacidosis (DKA) severity of children in type 1 diabetes mellitus (T1DM). Methods We retrospectively analyzed 167 T1DM children who were diagnosed with T1DM from January 2015 to December 2020. The clinical characteristics, laboratory indicators and thyroid function status of the four groups including non DKA, mild, moderate and severe DKA in T1DM were compared, and the related factors affecting serum free triiodothyronine (FT₃） level were analyzed. Results Among 167 patients with newly diagnosed T1DM, there were 81 males and 86 females, with a median age of 6.5 (4.0-9.9) years and a median course of disease of 14 (7-28) days. There were 104 cases in non DKA group, 20 cases in mild DKA group, 16 cases in moderate DKA group and 27 cases in severe DKA group. The FT₃, total triiodothyronine (TT₃), total thyroxine (TT₄), pH and HCO^-₃ in DKA groups were significantly lower than those in non DKA group, while the levels of anion gap and blood glucose were significantly higher than those in non DKA group, and the levels of WBC and the percentage of neutrophil in severe DKA group were significantly higher than those in other groups (P<0.05). There were 92 cases of normal thyroid function, 52 cases of non-thyroidal illness syndrome (NTIS), 10 cases of subclinical hypothyroidism, 6 cases of subclinical hyperthyroidism, 3 cases of hypothyroidism and 4 cases of hyperthyroidism. The severity of diabetes with DKA is associated with different thyroid function (P<0.01). The incidence of normal thyroid function in non DKA group was higher and the incidence of NTIS was lower. The multivariate regression analysis showed that FT₃ was negatively correlated with anion gap, blood glucose (P<0.01). Conclusions FT₃, TT₃ and TT₄ in DKA groups were lower than those in non DKA group. The incidence of NTIS in DKA group was significantly higher than that in non DKA group. Determination of thyroid hormone levels can provide a reliable basis for clinical judgment of thyroid diseases and diabetes mellitus.

Key words: type 1 diabetes, diabetic ketoacidosis, thyroid hormone, thyroid function, child

JIANG Mingyu, YIN Xiaoqin, LI Pin. Correlation analyses between thyroids function and diabetic ketoacidosis severity in T1DM children[J].Journal of Clinical Pediatrics, 2022, 40(5): 339-344.

Figures/Tables 3

项目	非DKA组(n=104)	轻度DKA组(n=20)	中度DKA组(n=16)	重度DKA组(n=27)	统计量	P
性别(男/女)	53/51	7/13	6/10	15/12	χ²=3.02	0.388
年龄[M(P₂₅~P₇₅)]/岁	6.4(4.0~9.8)	5.6(4.1~9.9)	7.8(3.3~10.0)	7.4(4.4~9.4)	H=0.31	0.958
病程[M(P₂₅~P₇₅)]/d	20.0(10.0~28.0)	14.0(7.0~21.0)	14.0(7.0~28.0)	14.0(5.0~56.0)	H=4.65	0.199
HtSDS[M(P₂₅~P₇₅)]	0.4(-0.4~1.1)	0.6(-0.3~0.8)	0.2(-0.4~2.2)	0.0(-0.8~1.4)	H=1.25	0.741
WtSDS[M(P₂₅~P₇₅)]	0.0(-0.6~0.8)	0.0(-0.3~0.2)	-0.4(-1.1~1.0)	0.0(-0.6~0.3)	H=0.50	0.920
BMI(x±s)/kg·m^-2	15.4±2.0	15.3±1.9	15.5±3.0	15.7±2.0	F=0.22	0.884
FT₃(x±s)/pmol·L^-1	5.0±1.2	4.3±1.1¹⁾	4.3±0.9¹⁾	4.0±1.2¹⁾	F=6.96	<0.001
FT₄(x±s)/pmol·L^-1	13.0±4.0	12.0±3.8	9.6±3.2	10.3±3.4	F=6.31	0.195
TT₃[M(P₂₅~P₇₅)]/nmol·L^-1	1.1(0.8~1.3)	0.6(0.4~0.9)¹⁾	0.6(0.3~0.9)¹⁾	0.6(0.3~0.9)¹⁾	H=36.80	<0.001
TT₄[M(P₂₅~P₇₅)]/nmol·L^-1	92.9(81.6~107.5)	74.5(63.8~93.2)¹⁾	57.0(39.4~85.4)¹⁾	75.4(44.1~83.7)¹⁾	H=36.47	<0.001
TSH[M(P₂₅~P₇₅)]/uIU·mL^-1	1.9(1.4~2.6)	1.9(0.5~3.1)	1.4(0.8~2.5)	1.1(0.8~2.1)	H=5.03	0.118
WBC[M(P₂₅~P₇₅)]/×10⁹·L^-1	7.0(4.1~8.6)	8.0(6.1~9.1)	9.1(7.0~11.9)	16.6(6.5~22.3)¹⁾²⁾³⁾	H=26.60	<0.001
NE(x±s)/%	45.8±13.0	55.3±13.2	57.4±16.2	67.2±19.5¹⁾²⁾³⁾	F=17.13	<0.001
HCT(x±s)/%	38.0±3.3	37.5±4.0	40.4±4.0	39.6±4.6	F=3.40	0.276
pH值(x±s)	7.4±0.1	7.3±0.1¹⁾	7.2±0.1¹⁾	7.0±0.1¹⁾	F=396.32	<0.001
HCO^-₃(x±s)/mmol·L^-1	21.4±5.2	12.8±2.1¹⁾	7.4±2.2¹⁾	3.6±1.4¹⁾	F=156.04	<0.001
AG[M(P₂₅~P₇₅)]/mmol·L^-1	13.5(9.7~17.6)	26.0(22.0~27.7)¹⁾	23.6(20.9~28.6)¹⁾	28.4(26.0~30.0)¹⁾	H=90.68	<0.001
BG(x±s)/mmol·L^-1	20.5±7.1	23.7±5.5¹⁾	25.3±3.6¹⁾	25.3±4.9¹⁾	F=6.14	0.001
HbA1c(x±s)/%	12.4±2.7	13.4±2.9	12.9±2.0	12.9±2.3	F=1.04	0.375
空腹C肽[M(P₂₅~P₇₅)]/nmol·L^-1	0.1(0.0~0.1)	0.1(0.0~0.1)	0.1(0.0~0.1)	0.1(0.0~0.1)	H=2.56	0.465
三酰甘油[M(P₂₅~P₇₅)]/mmol·L^-1	1.3(0.9~2.2)	2.8(1.2~5.3)	1.5(1.0~6.0)	2.1(1.4~3.0)	H=4.19	0.112
胆固醇(x±s)/mmol·L^-1	5.1±1.4	5.2±1.5	5.8±1.3	5.3±1.7	F=1.41	0.243
HDL-C[M(P₂₅~P₇₅)]/mmol·L^-1	1.2(1.0~1.5)	0.9(0.6~1.2)	1.3(0.9~1.4)	1.0(0.7~1.5)	H=5.58	0.132
LDL-C[M(P₂₅~P₇₅)]/mmol·L^-1	3.0(2.2~3.7)	2.9(1.9~3.9)	3.5(2.5~3.9)	2.5(1.9~3.4)	H=3.75	0.289

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组别	例数	甲状腺功能正常	NTIS	亚临床甲状腺功能减退症	亚临床甲状腺功能亢进症	甲状腺功能减退症	甲状腺功能亢进症
非DKA组	104	70(67.3)	19(18.3)	6(5.8)	3(2.9)	3(2.9)	3(2.9)
轻度DKA组	20	7(35.0)	9(45.0)	2(10.0)	1(5.0)	0(0.0)	1(5.0)
中度DKA组	16	5(31.3)	10(62.5)	1(6.3)	0(0.0)	0(0.0)	0(0.0)
重度DKA组	27	10(37.0)	14(51.9)	1(3.7)	2(7.4)	0(0.0)	0(0.0)

因素	回归系数	标准误	标准化回归系数	t值	P	95%CI
AG	-0.03	0.01	-0.31	-3.96	<0.001	-0.05~-0.02
血糖	-0.03	0.02	-0.16	-2.12	0.036	-0.06~-0.00
常量	6.02	0.33	-	18.04	<0.001	5.36~6.68

Correlation analyses between thyroids function and diabetic ketoacidosis severity in T1DM children

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