目的:探讨1型糖尿病(T1DM)合并酮症酸中毒(DKA)及正常甲状腺病态综合征(ESS)患者3型脱碘酶(D3) mRNA水平的变化及其发生机制.方法:T1DM并DKA及ESS患者28例,于确诊24 h内及DKA纠正后7d及14 d采血,选取同期住院的不伴感染、甲状腺疾病、缺氧、手术或禁食的同年龄同性别患者30例为对照组.采用放射免疫分析法检测血清T3、T4、FT3、FT4及TSH,采用Real-time PCR法测定血液D3 mRNA的表达水平.结果:DKA患者T3、FT3及FT4水平明显低于对照组,随着DKA的纠正,其水平逐渐回升,直至DKA后14d,FT3及FT4恢复至对照组水平,而T3仍未恢复至对照组水平.与之相对应,DKA者D3mRNA水平明显高于对照组,随着DKA的纠正,D3 mRNA水平逐渐下降,14 d仍未降至对照组水平.结论:D3 mRNA水平的变化可能是T1 DM合并DKA患者发生ESS的关键.%Objective; To investigate the iodothyronine deiodinase type ffl (D3) mRNA level in patients with type 1 diabetes mellitus ( Tl DM) and diabetic ketoacidosis ( DKA) complicated with euthyroid sick syndromes (ESS). Methods; Blood samples of 28 cases with T1DM and DKA complicated with ESS were collected 24 hours after being diagnosed, 7 and 14 days after DKA being corrected. Meanwhile, 30 cases with matched age and sex, and without infection, thyroid disease, anoxia, operation or fasting, were selected as control group. Serum T3, T4 , FT3, FT4 and TSH levels were measured by RIA, while D3 mRNA level was assessed by real time polymerase chain reaction (Real-time PCR). Results; T3, FT3 and FT4 concentrations of DKA patients were significantly lower than those of control group, but recovered 14 days after DKA corrected except for T3. D3 mRNA level of DKA patients was significantly higher than that of control group. Although decline of D3 mRNA was revealed after DKA corrected , no complete recovery was observed. Conclusion: The alteration of D3 mRNA may contribute to ESS pathogen-esis in patients with T1DM and DKA.
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