| Objectives To study the changes in pancreaticβ-cell function,thyroid hormone and Insulin-like growth factor-1（IGF-1）levels during type 1 diabetic ketoacidosis（DKA）and the correlation with each index to understand the clinical value of each change in determining the criticality of diabetic ketoacidosis.Methods A total of 93 children with T1DM hospitalized in Tangshan Pediatric Maternity and Children’s Health Care Centers from March 2016 to March 2021 were collected,including 34 cases in the non-DKA group and 59 cases in the DKA group,including 30cases of mild-to-moderate and 29 cases of severe.General data of the children and laboratory data of IGF-1,fasting C-peptide and thyroid function were collected.Paired samples t-test was used for intra-group comparisons,and ANOVA was used for comparisons between multiple groups.Count data were expressed as rates,and comparisons were made using chi-square tests.Pearson correlation was used to analyze the correlation of fasting C-peptide,thyroid function and IGF-1 with each laboratory index in the DKA group in the acute phase.Results 1 The fasting C-peptide in the severe group was lower than that in the non-DKA group and the mild-to-moderate group,and the difference was statistically significant（F=8.343,P<0.05）;the difference between fasting C-peptide in the acute phase and before discharge was not statistically significant in any group（t=1.220,0.442,-1.350,P>0.05）.2IGF-1 was lower in the mild-to-moderate and severe groups than that in the non-DKA group,and the difference was statistically significant（F=5.557,P<0.05）;IGF-1 levels before discharge were higher in all groups than before treatment,and the difference was statistically significant（t=-9.463,-13.197,-15.458,P<0.05）.3 The mild-to-moderate group（TT4,FT4）and the severe group（TT3,TT4,FT4,FT3）were lower than the non-DKA group,and the difference was statistically significant（P<0.05）,and the TT3,TT4,FT4,FT3 in the severe group were lower than the mild-to-moderate group,and the difference was statistically significant（P<0.05）.The pre-discharge in the non-DKA group（TSH,TT3）,mild-to-moderate group（TT3,TT4）and severe group（TSH,TT3,TT4,FT4,FT3）were higher than before treatment,and the difference was statistically significant（P<0.05）.The differences in TSH,TT3,TT4,FT4,FT3 between the mild-to-moderate group and the severe group at 1 month,3 months and 6 months after discharge were not statistically significant（P>0.05）.4 There was a statistically significant difference between the pre-treatment and pre-discharge incidence of thyroid hormone reduction in the non-DKA,mild-to-moderate and severe groups（χ2=8.743,8.297,4.72,P<0.05）.The incidence of thyroid hormone reduction before treatment was statistically higher in the severe group than in the non-DKA group and the mild-to-moderate group（F=15.194,P<0.05）.5Pearson correlation analysis was used to find that fasting C-peptide,TT3,TT4,and IGF-1were positively correlated with DKA（P<0.05）;fasting C-peptide,TT3,TT4,FT4,and FT3were positively correlated with p H and HCO3-（P<0.05）,while TT3 and TT4 were negatively correlated with glycated hemoglobin,triglycerides,and blood creatinine（P<0.05）;FT4 and FT3 were negatively correlated with triglycerides（P<0.05）.Conclusions 1 The more severe the degree of DKA occurs in children with T1DM,the worse the pancreaticβ-cell function,and there is no significant improvement in pancreaticβ-cell function in a shorter period of time.2 The more severe the degree of DKA,the higher the incidence of thyroid hormone reduction and the lower the thyroid hormone levels.In the absence of combined autoimmune thyroid disease,changes in thyroid function are reversible.3 IGF-1 is significantly reduced when DKA occurs,but there is no significant difference between mild-to-moderate and severe DKA.4 Fasting C-peptide and thyroid hormone correlate well with p H,HCO3-,lipids,and renal function,providing a basis for comprehensive assessment of DKA.Figure0;Table12;Reference 101... |
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