儿童1型糖尿病合并自身免疫性甲状腺疾病12例临床分析

目的 分析儿童1型糖尿病(T1DM)合并自身免疫甲状腺疾病(AITD)对T1DM治疗的影响。方法 1993～2002年在我院诊治的T1DM患儿合并甲状腺疾病者12例。对患儿的病史、家族史、体格检查及内分泌相关检查的结果进行分析。抗体检查：GAD-Ab、IAA、ICA、TG-Ab、TPO-Ab、TRAb和肾上腺皮质细胞浆抗体(ACC)。采用t检验将T1DM合并Graves病(GD)与合并桥本甲状腺炎(HT)者进行糖化血红蛋白(HbA1c)和胰岛素用量的分组比较；采用秩和检验对病程进行比较。结果 该组儿童患GD和HT者，分别为4例和8例。T1DM和AITD发病间隔为0～10年；GD的临床表现可不突出。有内分泌家族史者占25％。GD控制前患儿的HbA1c分别为10％、12％和14％，1例结束GD疗程者的HbA1c为7．8％。合并HT者的糖尿病代谢控制相对较好，HbA1c为7．2％～10％，1例新诊断T1DM合并HT且尚未治疗HT的患儿，HbA1c为6．3％。经t检验显示两组患儿的HbA1c差异有显著意义(P=0．011)，而病程和胰岛素用量差异无显著意义。结论该组患儿女性多于男性；HT患儿较GD患儿为多；有较强的内分泌疾病家族史。AITD影响糖尿病控制。T1DM患儿宜定期进行甲状腺自身抗体和甲状腺功能检查。

Clinical analysis of 12 cases with type 1 diabetes and autoimmune thyroid disease

Objective The clinical features of 12 cases with T1DM and autoimmune thyroid disease (AITD) and the influence of AITD on the metabolic control of T1DM were analyzed Method Analysis of the 12 cases included general data, family history, physical signs and the levels of related hormones and antibodies with t test for insulin dose and HbA 1c between groups And Mann Whitney test was used for the course analysis Result the onset age of this group was at 7 to 13 yrs with median age of 11 Boys to girls were 3 to 8 The onset interval between T1DM and AITD was 0 to 10 years There were 4 cases of Graves disease and 8 cases of Hashimoto disease The positive rate of DM or AITD family history was 25% The clinical expression of thyroid diseases was recessive, and may be thought as the symptoms of diabetes or ignored The metabolic control of the patients with T1DM and HT was better than those with T1DM and GD the HbA 1c difference was significantl, P =0 011 The differences in course and insulin dose were not different significantly between the 2 groups Conclusion Thyroid disorders affect the metabolic control of diabetes It is necessary to test the thyroid function and related antibodies early and regularly for T1DM patient