中老年人促甲状腺素水平与新发非酒精性脂肪性肝病的相关性研究  

Association between thyroid stimulating hormone and incident non-alcoholic fatty liver disease in middle-aged and elderly population

作　　者：刘丽娟[1] 甄东户[1] 汤旭磊[1] 傅松波[1] 杨晓梅[1] 马小妮 LIU Lijuan;ZHEN Donghu;TANG Xulei;FU Songbo;YANG Xiaomei;MA Xiaoni(Department of Endocrinology,the First Hospital of Lanzhou University,Lanzhou 730000,China)

机构地区：[1]兰州大学第一医院内分泌科,甘肃兰州730000

出　　处：《南京医科大学学报（自然科学版）》2021年第3期369-375,共7页Journal of Nanjing Medical University(Natural Sciences)

基　　金：甘肃省卫生行业科研计划(GSWSKY-2014-27,GSWST2010-03);甘肃省自然科学基金计划项目(1606RJZA347);标准化代谢性疾病管理中心(MMC)专项研究基金(2018-mmczxjj-3)。

摘　　要：目的:分析兰州市社区中老年人群促甲状腺素(thyroid stimulating hormone,TSH)水平与3年随访时新发非酒精性脂肪性肝病(non-alcoholic fatty liver disease,NAFLD)的相关性。方法:选取兰州市社区2011年基线调研时40~75岁甲状腺功能(甲功)正常(727例)及亚临床甲状腺功能减退症(亚临床甲减,222例)的无脂肪肝人群,于2014年进行随访,采集人体学指标,检测甲状腺激素水平、血糖、血脂、肝酶等,并检查上腹部超声。结果:亚临床甲减3年缓解率为27.93%(62/222);基线甲功正常人群中亚临床甲减3年新发率为16.64%(121/727)。随着基线TSH水平的升高,总胆固醇(total cholesterol,TC)、甘油三酯(triglyceride,TG)、低密度脂蛋白胆固醇(low density lipoprotein cholesterol,LDL-C)、天门冬氨酸氨基转移酶(aspartate aminotransferase,AST)水平逐渐升高(P均<0.05)。仅在女性中,不同基线TSH水平人群NAFLD 3年发病率差异有统计学意义(P <0.05)。Logistic回归分析显示,女性中,在模型1未校正及模型2校正年龄、基线体重指数(body mass index,BMI)、基线TG、基线糖化血红蛋白(HbA1c)后,基线TSH与NAFLD 3年发病风险呈正相关(P均<0.05);在模型3进一步校正BMI差值、HbA1c差值后,二者的相关性无统计学意义。结论:中老年女性中,基线TSH水平是NAFLD 3年发病的影响因素,但二者无独立相关性。Objective:The objective of the study was to investigate the association between thyroid stimulating hormone(TSH)and incident non-alcoholic fatty liver disease(NAFLD)in middle-aged and elderly population in a 3-year follow-up study. Methods:Total222 subclinically hypothyroid(TSH>4.50 mU/L)and 727 euthyroid people aged 40~75 years who were free of fatty liver disease at baseline in a community were included in the current study. The study population was screened initially in 2011 and re-evaluated in2014. On both occasions they were assessed by structured interview via a questionnaire on general information,anthropometric measurements,thyroid hormones,biochemical and serological tests,liver ultrasound. Results:Among 222 baseline subclinical hypothyroidism patients,62(27.93%) reverted to euthyroidism at a 3-year follow-up. The 3-year incidence of subclinical hypothyroidism was 16.64%(121/727). Higher TSH levels at baseline were associated with higher total cholesterol(TC),triglyceride(TG),low density lipoprotein cholesterol(LDL-C)and aspartate aminotransferase(AST)levels(P < 0.05). The incidence rate of NAFLD increased with increasing baseline TSH levels in female(P < 0.05). Logistic regression analyses showed,higher baseline TSH levels were associated with the diagnosis of NAFLD by unadjusted in model 1 in female. After adjustment for age,baseline BMI,baseline TG,baseline HbA1 c in model 2,this association remained significant. When data were adjusted for the changes in BMI and changes in HbA1 c in model 3,the association was no longer significant. Conclusion:Among middle-aged and elderly population,baseline TSH was an influencing factor,but not an independent risk factors,for 3-year incidence of NAFLD in female.

关 键 词：促甲状腺素 非酒精性脂肪性肝病 发病率 

分 类 号：K575.5[历史地理—历史学]