1 型糖尿病患儿和青少年甲状腺自身免疫的相关因素。
Factors for thyroid autoimmunity in children and adolescents with type 1 diabetes mellitus.
机构信息
Diabetic Clinic, B' Pediatric Department, University of Athens, P. & A. Kyriakou Children's Hospital, Athens, Greece.
出版信息
Ups J Med Sci. 2009;114(4):214-20. doi: 10.3109/03009730903276381.
INTRODUCTION
Type 1 diabetes mellitus (T1DM) is associated with an autoimmune reaction to thyroid antigens including thyroid peroxidase (anti-TPO) and thyroglobulin (anti-Tg).
AIMS
We determined in children with T1DM the relationship of positive anti-thyroid antibodies to potential risk factors, including, age, gender, duration of diabetes, and glutamic acid decarboxylase antibodies (anti-GAD).
MATERIALS AND METHODS
We studied 144 children and adolescents with T1DM. Their age was 12.3 +/- 4.6 (mean +/- SD) years, and duration of diabetes was 4.6 +/- 3.8 years. Anti-thyroid antibodies were determined using a luminescence method and anti-GAD using an enzyme-linked immunosorbent assay.
RESULTS
The prevalence rates of anti-thyroid antibodies among the children with T1DM in our study were: anti-TPO (17.4%), anti-Tg (11.1%), and of both anti-thyroid antibodies (10.4%). The presence of serum anti-thyroid antibodies was positively associated with age (16.6 years in those with positive tests versus 12.0 years in those with negative tests, P = 0.027), duration of diabetes (7.4 versus 4.3 years, P = 0.031), and serum TSH (Thyroid-stimulating hormone) levels (4.8 versus 2.3 microIU/mL, P = 0.002). The presence of both anti-thyroid antibodies was associated with female sex (boys: 4/75 (5.3%), girls: 11/69 (15.9%), chi-square = 6.44, P = 0.04). Subclinical autoimmune thyroiditis (SAIT) was present in 55.5% of the patients with thyroid antibody-positivity and was positively associated with age (16.6 versus 12.0 years, P = 0.001) and diabetes duration (7.6 versus 4.2 years, P = 0.001). Multiple logistic regression analysis revealed that the development of anti-thyroid antibodies was predicted by: 1) the presence of anti-GAD (odds ratio (OR) 1.45, 95% confidence interval (CI) 1.09-1.92), 2) the presence of a second anti-thyroid antibody (OR 134.4, 95% CI 7.7-2350.3), and 3) older age (OR 22.9, 95% CI 1.13-463.2).
CONCLUSIONS
Thyroid autoimmunity was associated with female gender, increasing age, long diabetes duration, the persistence of anti-GAD, and with TSH elevation, indicating subclinical hypothyroidism.
简介
1 型糖尿病（T1DM）与甲状腺抗原的自身免疫反应有关，包括甲状腺过氧化物酶（抗 TPO）和甲状腺球蛋白（抗 Tg）。
目的
我们在患有 T1DM 的儿童中确定了阳性抗甲状腺抗体与潜在危险因素之间的关系，包括年龄、性别、糖尿病持续时间和谷氨酸脱羧酶抗体（抗 GAD）。
材料和方法
我们研究了 144 名患有 T1DM 的儿童和青少年。他们的年龄为 12.3 ± 4.6（平均值 ± 标准差）岁，糖尿病持续时间为 4.6 ± 3.8 年。使用发光法测定抗甲状腺抗体，使用酶联免疫吸附试验测定抗 GAD。
结果
在我们的研究中，患有 T1DM 的儿童抗甲状腺抗体的患病率为：抗 TPO（17.4%）、抗 Tg（11.1%）和两种抗甲状腺抗体（10.4%）。血清抗甲状腺抗体的存在与年龄呈正相关（阳性组为 16.6 岁，阴性组为 12.0 岁，P = 0.027）、糖尿病持续时间（阳性组为 7.4 年，阴性组为 4.3 年，P = 0.031）和血清 TSH（促甲状腺激素）水平（阳性组为 4.8 微 IU/mL，阴性组为 2.3 微 IU/mL，P = 0.002）。两种抗甲状腺抗体的存在与女性性别有关（男孩：4/75（5.3%），女孩：11/69（15.9%），卡方=6.44，P=0.04）。亚临床自身免疫性甲状腺炎（SAIT）存在于 55.5%的甲状腺抗体阳性患者中，与年龄呈正相关（16.6 岁与 12.0 岁，P=0.001）和糖尿病持续时间（7.6 岁与 4.2 岁，P=0.001）。多因素逻辑回归分析显示，抗甲状腺抗体的发展可由以下因素预测：1）抗 GAD 的存在（优势比（OR）1.45，95%置信区间（CI）1.09-1.92），2）第二种抗甲状腺抗体的存在（OR 134.4，95%CI 7.7-2350.3），和 3）年龄较大（OR 22.9，95%CI 1.13-463.2）。
结论
甲状腺自身免疫与女性性别、年龄增长、糖尿病持续时间长、抗 GAD 持续存在以及 TSH 升高有关，提示亚临床甲状腺功能减退。
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