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目的探讨糖尿病酮症酸中毒合并低三碘甲状腺原氨酸(T3)综合征的临床意义及治疗原则。方法回顾性分析近5年中住院糖尿病酮症酸中毒患者治疗前及治疗后甲状腺功能的变化,以及糖尿病酮症酸中毒患者中pH<7.05与pH>7.05者的甲状腺功能情况。对照组为血糖控制良好的糖尿病患者。结果与对照组比较,糖尿病酮症酸中毒患者总T3(TT3)和游离T3(FT3)明显降低,反T3(rT3)升高(P均<0.05);治疗原发病后2周甲状腺激素恢复正常;TT3、FT3在pH<7.05患者较pH>7.05患者下降更明显,rT3在前组升高更明显,差异均有统计学意义(P均<0.05)。结论糖尿病酮症酸中毒合并低T3综合征常见,且甲状腺激素水平降低与酸中毒严重程度相关,抢救治疗过程中不需要补充甲状腺激素,只需治疗原发病。
Objective To investigate the clinical significance and treatment principles of diabetic ketoacidosis combined with low triiodothyronine (T3) syndrome. Methods The changes of thyroid function before and after treatment in patients with diabetic ketoacidosis in the past five years and the thyroid function in patients with diabetic ketoacidosis at pH <7.05 and pH> 7.05 were retrospectively analyzed. The control group was well-controlled diabetic patients. Results Compared with the control group, the total T3 (TT3) and free T3 (FT3) and the anti-T3 (rT3) were significantly increased in diabetic ketoacidosis patients (all P <0.05) Normal; TT3, FT3 in pH <7.05 patients with pH> 7.05 patients decreased more significantly, rT3 in the former group increased more significantly, the differences were statistically significant (P all <0.05). Conclusions Diabetic ketoacidosis is common in patients with low T3 syndrome, and the reduction of thyroid hormone level is related to the severity of acidosis. There is no need to supplement thyroid hormones during the rescue treatment, so long as the primary disease is treated.