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目的:了解1型糖尿病酮症酸中毒患儿病程中甲状腺激素水平的变化。方法:选取2017年12月至2020年12月山西省儿童医院内分泌科67例1型糖尿病酮症酸中毒急性期入院治疗且甲状腺激素检查结果完整［入院后急性期与恢复期（住院7~10 d后）］患儿为酸中毒组，其中男性36例、女性31例，1~10~14岁25例，轻度组（pH<7.3）22例、中度组（pH<7.2）16例、重度组（pH<7.1）29例；以44例入院时无临床合并症的1型糖尿病患儿为对照组，其中男性21例、女性23例，1~10~14岁15例。回顾性分析、比较各组入院后急性期与恢复期三碘甲状腺原氨酸（Tn 3）、甲状腺素（Tn 4）、游离Tn 3（FTn 3）、游离Tn 4（FTn 4）、促甲状腺激素（TSH）（甲状腺功能5项指标）水平的变化。酸中毒组急性期予均衡补液、输注胰岛素、纠酸纠酮治疗。n 结果:甲状腺功能5项指标水平酸中毒组急性期［Tn 3 0.48（0.19，0.67）nmol/L、Tn 4（49.99±26.06）nmol/L、FTn 3 1.80（1.24，2.51）pmol/L、FTn 4 9.74（7.21，12.85）pmol/L、TSH 0.86（0.31，1.81）mIU/L］，明显低于对照组［Tn 3 0.97（0.74，1.18）nmol/L、Tn 4（73.48±23.32）nmol/L、FTn 3 3.31（2.56，3.98）pmol/L、FTn 4 14.54（11.29，16.75）pmol/L、TSH 1.92（1.01，3.56）mIU/L］，差异均有统计学意义（Tn 3：n Z=-5.97，Tn 4：n t=4.68，FTn 3：n Z=-6.15，FTn 4：n Z=-5.23，TSH：n Z=-4.19，均n P<0.001）；酸中毒组恢复期［Tn 3 1.58（1.25，1.86）nmol/L、Tn 4（92.52±27.03）nmol/L、FTn 3 5.03（4.15，5.78）pmol/L、FTn 4 15.94（14.40，18.38）pmol/L、TSH 2.21（1.58，3.16）mIU/L］水平较急性期显著升高，差异均有统计学意义（Tn 3：n Z=-6.96，Tn 4：n t=-11.34，FTn 3：n Z=-7.00，FTn 4：n Z=-6.39，TSH：n Z=-5.28，均n P<0.001）。酸中毒组急性期Tn 3、FTn 3水平轻度组［0.60（0.47，0.78）nmol/L，2.20（1.47，2.89）pmol/L］、中度组［0.36（0.18，0.64）nmol/L，1.90（1.11，2.31）pmol/L］、重度组［0.35（0.16，0.54）nmol/L，1.48（1.08，1.89）pmol/L］均低于对照组（Tn 3：n Z=-3.44，n P=0.001；n Z=-3.97，n P<0.001；n Z=-5.63，n P<0.001；FTn 3：n Z=-3.44，n P=0.001；n Z=-4.13，n P<0.001；n Z=-5.86，n P<0.001），水平由高至低依次为对照组、轻度组、中度组、重度组；Tn 4、FTn 4水平中度组［（47.34±29.89）nmol/L，9.75（5.74，12.29）pmol/L］、重度组［（44.08±22.27）nmol/L，8.82（6.40，9.89）pmol/L］均低于对照组，差异均有统计学意义（Tn 4：n t=3.66，n t=5.01，均n P<0.001；FTn 4：n Z=-3.40，n P=0.001；n Z=-5.73，n P<0.001）；重度组TSH为0.63（0.27，1.33）mIU/L，低于与对照组（n Z=-4.23，n P<0.001），其中为正常值下限者9例，低于正常值者13例，且酸中毒程度越重水平下降越明显。酸中毒组恢复期轻度、中度、重度组Tn 3［1.69（1.22，1.87），1.68（1.24，1.84）和1.55（1.25，1.86）nmol/L］、FTn 3［5.27（4.37，5.76），4.32（4.17，5.73）和5.04（3.81，5.79）pmol/L］、Tn 4［（87.41±18.40），（90.02±30.41）和（97.34±30.10）nmol/L］、FTn 4［16.05（14.23，17.71），15.26（14.40，16.11）和16.88（13.98，18.89）pmol/L］水平均高于对照组，除中度组FTn 4，差异均有统计学意义（Tn 3：n Z=-4.55，n Z=-3.87，n Z=-4.93，均n P<0.001；FTn 3：n Z=-4.72，n Z=-3.72，n Z=-4.52，均n P<0.001；Tn 4：n t=-2.01，n P=0.047；n t=-2.15，n P=0.034；n t=-3.88，n P<0.001；FTn 4：n Z=-2.21，n P=0.027；n Z=-0.84，n P=0.399；n Z=-2.67，n P=0.008）；TSH水平［2.28（1.88，3.16），2.19（1.26，3.57）和2.18（1.36，3.09）mIU/L］与对照组比较，差异无统计学意义（n Z=-0.80，n P=0.426；n Z=-0.31，n P=0.754；n Z=-0.05，n P=0.959）。n 结论:儿童1型糖尿病合并酮症酸中毒患者甲状腺功能水平均随酮症酸中毒加重而明显下降；酮症酸中毒纠正后其水平能基本恢复至正常。“,”Objective:To investigate the changes of thyroid hormone level in children with type 1 diabetic mellitus (T1DM) complicated with ketoacidosis.Methods:Sixty-seven children with acute T1DM and ketoacidosis admitted in Department of Endocrinology, Shanxi Children′s Hospital from December 2017 to December 2020 were enrolled as acidosis group; and 44 T1DM children without ketoacidosis at admission served as control group. According to blood gas analysis, in acidosis patients there were 22 cases in mild group (pH<7.3), 16 cases in moderate group (pH<7.2) and 29 cases in severe group (pH<7.1). Serum levels of triiodothyronine (Tn 3), thyroxine (Tn 4), free Tn 3(FTn 3), free Tn 4(FTn 4), thyroid stimulating hormone (TSH) were measured in all patients at admission and recovery, retrospectively. Patients in the acidosis group at acute stage were treated with balanced fluid infusion, insulin infusion and eritone.n Results:The serum levels of Tn 3 [0.48(0.19, 0.67)nmol/L n vs. 0.97(0.74, 1.18)nmol/L, n Z=-5.97,n P<0.001], Tn 4 [(49.99±26.06) nmol/L n vs. (73.48±23.32)nmol/L, n t=4.68, n P<0.001], FTn 3 [1.80(1.24, 2.51) pmol/L n vs. 3.31(2.56, 3.98) pmol/L, n Z=-6.15,n P<0.001], FTn 4 [9.74 (7.21, 12.85)pmol/L vs. 14.54 (11.29, 16.75)pmol/L, n Z=-5.23,n P<0.001] and TSH [0.86(0.31, 1.81) mIU/Ln vs. 1.92(1.01, 3.56)mIU/L, n Z=-4.19, n P<0.001] in acidosis group at acute stage were significantly lower than those in the control group. In acidosis group at recovery stage serum levels of Tn 3 [1.58 (1.25, 1.86)nmol/L], Tn 4 [(92.52±27.03) nmol/L], FTn 3 [5.03(4.15, 5.78) pmol/L], FTn 4 [15.94 (14.40, 18.38)pmol/L], and TSH [2.21(1.58, 3.16)mIU/L] were significantly higher than those at acute stage (n Z=-6.96, n t=-11.34, n Z=-7.00,n Z=-6.39,n Z=-5.28,all n P<0.001). There was an decreasing trend of Tn 3 and FTn 3 levels from mild group [0.60 (0.47, 0.78)nmol/L, 2.20(1.47, 2.89) pmol/L], moderate group [0.36(0.18, 0.64)nmol/L, 1.90(1.11, 2.31)pmol/L] to severe acidosis group [0.35(0.16, 0.54) nmol/L, 1.48(1.08, 1.89)pmol/L](Tn 3:n Z=-3.44, n P=0.001;n Z=-3.97,n P<0.001;n Z=-5.63, n P<0.001;FTn 3:n Z=-3.44,n P=0.001;n Z=-4.13,n P<0.001;n Z=-5.86, n P<0.001). Compared to control group serum Tn 4 and FTn 4 levels in moderate group [(47.34±29.89)nmol/L and 9.75(5.74,12.29)pmol/L] and severe group [(44.08±22.27)nmol/L and 8.82 (6.40, 9.89)pmol/L] were significantly decreased (Tn 4:n t=3.66,n t=5.01,all n P<0.001; FTn 4: n Z=-3.40,n P=0.001;n Z=-5.73,n P<0.001). The TSH level in severe acidosis group [0.63 (0.27, 1.33)mIU/L] was lower than that in the control group (n Z=-4.23,n P<0.001). At the recovery stage the serum levels of Tn 3 [1.69 (1.22, 1.87)nmol/L,1.68 (1.24, 1.84)nmol/L,1.55(1.25, 1.86) nmol/L], FTn 3 [5.27 (4.37, 5.76)pmol/L,4.32(4.17, 5.73)pmol/L,5.04(3.81, 5.79)pmol/L], Tn 4 [(87.41±18.40)nmol/L,(90.02±30.41)nmol/L,(97.34±30.10)nmol/L] and FTn 4 [16.05(14.23, 17.71) pmol/L,15.26(14.40, 16.11)pmol/L,16.88(13.98, 18.89) pmol/L] in the mild, moderate and severe acidosis groups were higher than those in the control group (Tn 3:n Z=-4.55, n Z=-3.87, n Z=-4.93,all n P<0.001;FTn 3:n Z=-4.72, n Z=-3.72,n Z=-4.52,all n P<0.001;Tn 4:n t=-2.01, n P=0.047;n t=-2.15, n P=0.034;n t=-3.88, n P0.05).n Conclusions:Thyroid function in T1DM children complicated with ketoacidosis is decreased significantly with the aggravation of acidosis. After correction of ketoacidosis, the level of thyroid function can basically return to normal.