糖尿病酮症酸中毒患者甲状腺功能状态分析

目的 分析糖尿病酮症酸中毒(DKA)患者甲状腺功能(甲功)状态.方法 选择广西医科大学第九附属医院2005年11月至2013年12月住院DKA患者93例,并按性别、年龄(≤30岁组、30 ～ 60岁组、≥60岁组)、糖尿病分型(1型糖尿病、2型糖尿病)进行分组,测定各组血清FT3、FT4、促甲状腺激素(TSH)水平,并进行比较.结果 甲功正常的病态综合征(ESS)发生率为79.6％(74/93),甲功正常为9.7％ (9/93),甲状腺功能亢进症发生率为7.5％ (7/93),亚临床甲状腺功能亢进症发生率为2.2％ (2/93),甲状腺功能减退症发生率为1.1％ (1/93).男性组DKA患者的FT3水平低于女性组(t=-2.046,P=0.044),FT4、TSH比较差异无统计学意义;1型糖尿病组FT4水平低于2型糖尿病组(t-2.352,P=0.021),但TSH高于2型糖尿病组(t=2.454,P=0.016),FT3比较差异无统计学意义(P＞0.05).1型糖尿病组低T3/T4综合征比例高于2型糖尿病组(x2 =4.443,P =0.035).低T3综合征比例随着年龄增加有增加的趋势(x2=7.081,P=0.029);低T3/T4综合征比例随着酸中毒严重程度的增加有增加的趋势(x2=6.759,P=0.034).结论 DKA患者甲功异常发生率较高,甲功异常表现形式多样,ESS最常见.

Analysis of thyroid function in patients with diabetic ketoacidosis

Objective To investigate the thyroid function of patients with diabetic ketoacidosis (DKA).Methods A total of 93 DKA patients admitted to the 9th Affiliated Hospital of Guangxi Medical University from November 2005 to December 2013 were selected and divided into subgroups according to age (≤30 years,30-60 years,and ≥60 years),gender (male,female) and type of diabetes [(type 2 diabetes mellitus (T2DM),type 1 diabetes mellitus (T1DM)].FT3,FT4 and thyroid stimulating hormone (TSH)were measured and compared among groups.Results 79.6％ (74/93) of patients with DKA were found with euthyroid sick syndrome (ESS),9.7 ％ (9/93) had normal thyroid function,7.5 ％ (7/93) had hyperthyroidism,2.2％ (2/93) were with subclinical hyperthyroidism,and 1.1％ (1/93) were diagnosed with hypothyroidism.The level of serum FT3 was lower in male group than that in female group (t =-2.046,P =0.044),whereas the levels of FT4,TSH had no differences between male group and female group.Compared with T2DM group,T1DM group had lower FT4 level (t=-2.352,P=O.021),higher TSH level (t =2.454,P=0.016),and FT3 level had no difference(P＞0.05).The proportion of low T3/T4 syndrome in T1DM group was higher than that in T2DM group (x2 =4.443,P =0.035).The percentage of low T3 syndrome tended to increase with age (x2 =7.081,P =0.029),whereas the proportion of low T3/T4 syndrome tended to increase with the severity of ketoacidosis (x2 =6.759,P =0.034).Conclusions The incidence of thyroid dysfunction in patients with DKA is high,and have various manifestations.ESS is the most common type of thyroid dysfunction.