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目的研究1型糖尿病(T1DM)患儿甲状腺功能状态,并探讨胰岛自身抗体阳性是否可预测自身免疫性甲状腺疾病的发生。方法选取2005年1月-2008年9月在中国医科大学附属盛京医院住院新发且资料完整的71例T1DM患儿,进行2～4 a的随访,对其年龄、性别、家族史及内分泌相关检查结果进行分析。对胰岛自身抗体[谷氨酸脱羧酶抗体(GADA)、胰岛细胞抗体(ICA)、胰岛素自身抗体(IAA)、胰岛素瘤相关蛋白2抗体(IA-2)]及甲状腺自身抗体[甲状腺过氧化物酶抗体(TPOAb)、甲状腺球蛋白抗体(TGAb)]检测结果进行分析。结果胰岛自身抗体的检测阳性率:ICA为12.7%(9/71例),IAA为36.6%(26/71例),GADA为54.9%(39/71例),IA-2为46.5%(33/71例)。甲状腺自身抗体检测阳性率:TPOAb阳性率为11.3%(8/71例),TGAb阳性率为8.5%(6/71例),APOAb、TGAb任一抗体阳性率为12.7%(9/71例)。10岁以上患儿甲状腺抗体阳性率高(P=0.031)。甲状腺抗体阳性患儿更易发生甲状腺功能异常(促甲状腺激素:5.6%vs 0,P<0.05)。GADA阳性组甲状腺功能异常率及抗体的阳性率较GADA阴性组偏高,但无统计学差异(TPOAb:8.5%vs 2.8%,P>0.05;TGAb:5.6%vs 2.8%,P>0.05),ICA、IAA阳性组与阴性组比较差异无统计学意义。IA-2阳性组TSH阳性率与IA-2阴性组比较有统计学差异(促甲状腺激素:5.6%vs 0,P<0.05)。71例患儿经过2～4 a随访,无新发甲状腺疾病。结论 IA-2阳性的T1DM患儿可能更易发生甲状腺功能异常。10岁以上T1DM患儿有必要动态监测甲状腺功能。
Objective To study the thyroid function in children with type 1 diabetes mellitus (T1DM) and to investigate whether the islet autoantibodies could predict the occurrence of autoimmune thyroid disease. Methods Totally 71 T1DM patients newly admitted in Shengjing Hospital Affiliated to China Medical University from January 2005 to September 2008 were followed up for 2 ~ 4 years and their age, gender, family history and endocrine Related inspection results for analysis. The effects of islet autoantibodies (GADA, ICA, IAA, IA-2) and thyroid autoantibodies [thyroid peroxidation Enzyme antibody (TPOAb), thyroglobulin antibody (TGAb)] test results were analyzed. Results The positive rates of islet autoantibodies were 12.7% (9/71) in ICA, 36.6% (26/71) in IAA, 54.9% (39/71) in GADA and 46.5% / 71 cases). The positive rate of thyroid autoantibodies was 11.3% (8/71), 8.5% (6/71) for TGAb, 12.7% (9/71) for any antibody of APOAb and TGAb, . Thyroid antibodies positive rate in children over 10 years old (P = 0.031). Thyroid dysfunction is more likely to occur in children with thyroid antibodies (thyroid stimulating hormone: 5.6% vs 0, P <0.05). The positive rates of thyroid dysfunction and antibody in GADA positive group were higher than those in GADA negative group, but there was no significant difference (P> 0.05; TGAb: 5.6% vs 2.8%, P> 0.05) There was no significant difference between ICA and IAA positive group and negative group. The positive rate of TSH in IA-2 positive group was statistically different from that in IA-2 negative group (thyroid-stimulating hormone: 5.6% vs 0, P <0.05). 71 cases of children after 2 ~ 4 a follow-up, no new thyroid disease. Conclusion IA-2-positive T1DM children may be more prone to thyroid dysfunction. It is necessary to monitor thyroid function dynamically in children with T1DM over 10 years old.