亚临床甲状腺功能异常与2型糖尿病合并NAFLD的关系  

Relationship between subclinical thyroid dysfunction and NAFLD in type 2 diabetes mellitus

作　　者：崔琦 关宝杰 管圆圆 隋晓婵 周虹 胡晓姣 张帅 CUI Qi;GUAN Bao-jie;GUAN Yuan-yuan;SUI Xiao-chan;ZHOU Hong;HU Xiao-jiao;ZHANG Shuai(Department of Endocrinology,Jilin Province FAW General Hospital,Changchun,Jilin 130011,China)

机构地区：[1]吉林省一汽总医院内分泌科,吉林长春130011

出　　处：《中国临床研究》2021年第7期872-876,共5页Chinese Journal of Clinical Research

基　　金：吉林省自然科学基金(20200201587JC)。

摘　　要：目的探讨游离三碘甲状腺原氨酸(FT_(3))及游离甲状腺素(FT_(4))在正常参考范围内时,甲状腺激素水平与2型糖尿病(T2DM)合并非酒精性脂肪性肝病(NAFLD)的相关性。方法采用回顾性研究方法,选出2018年4月至2020年3月于吉林省一汽总医院住院的T2DM患者149例,按腹部B超结果诊断NAFLD,其中合并NAFLD 60例(NAFLD组),单纯T2DM 89例(对照组)。所有患者均计算BMI,检测血清糖化血红蛋白(HbAlc)、空腹血清C肽、FT_(3)、FT_(4)、促甲状腺激素(TSH)等指标。根据TSH水平将所有患者分为甲状腺功能正常亚组60例、亚临床甲状腺功能减退症(亚临床甲减)亚组61例、亚临床甲状腺功能亢进症(亚临床甲亢)亚组28例,比较三组T2DM合并NAFLD的患病率。结果 NAFLD组的空腹C肽及BMI、TG、ALT、AST、GGT、FT_(3)、FT_(3)/FT_(4)、TSH水平均高于对照组(P<0.05,P<0.01);经混杂因素校正后,FT_(3)及TSH仍为T2DM合并NAFLD的危险因素[OR=3.311,95%CI(1.497-3.485),P=0.002;OR=2.351,95%CI(1.163-4.754),P=0.017],而FT_(3)/FT_(4)并非其影响因素[OR=25.440,95%CI(1.910-92.086),P=0.378]。在不同甲状腺功能亚组,随甲状腺功能的递降(亚临床甲亢→甲状腺功能正常→亚临床甲减),T2DM合并NAFLD的患病率递升(17.9%→35.0%→55.7%,P<0.01)。经Logistic回归分析显示,亚临床甲减[OR=2.137,95%CI(1.031-4.428),P=0.041]为NAFLD合并T2DM的独立危险因素,而亚临床甲亢[OR=0.914,95%CI(0.679-1.231),P=0.064]不是NAFLD合并T2DM的影响因素。结论 FT_(3)及TSH与T2DM合并NAFLD密切相关,亚临床甲减可能为T2DM合并NAFLD的独立危险因素。Objective To explore the correlation between thyroid hormone levels and type 2 diabetes(T2 DM) combined with non-alcoholic fatty liver disease(NAFLD) when free triiodothyronine(FT_(3)) and free thyroxine(FT_(4)) were within the normal reference range.Methods A retrospective study was conducted in 149 T2 DM patients.The patients were divided into T2 DM with NAFLD group(NAFLD group,n=60) and simple T2 DM group(control group,n=89) based on findings of abdominal ultrasonography.Body mass index(BMI) and the levels of fasting serum C-peptide,serum glycosylated hemoglobin(HbAlc),FT_(3),FT_(4) and thyroid stimulating hormone(TSH) were measured in two groups.According to the level of TSH, all patients were divided into normal thyroid function subgroup(n=60), subclinical hypothyroidism subgroup(n=61) and subclinical hyperthyroidism subgroup(n=28). The prevalence rate of T2 DM complicated with NAFLD in three subgroups was compared.Results The levels of fasting serum C-peptide,BMI,triglyceride(TG),alanine aminotransferase(ALT),aspartate aminotransferase(AST),alkaline phosphatase(ALP),γ-glutamyltransferase(GGT),FT_(3),FT_(3)/FT_(4) and TSH in NAFLD group were significantly higher than those in control group(P<0.05,P<0.01).After adjusting for confounding factors,the levels of FT_(3) and TSH were still risk factors for T2 DM with NAFLD,respectively [OR=3.311,95% CI(1.497-3.485),P=0.002;OR=2.351,95% CI(1.163-4.754),P=0.017],but FT_(3)/FT_(4) was not the influencing factor[OR=25.440,95%CI(1.910-92.086),P=0.378].In different thyroid function subgroups, with the declining thyroid function(subclinical hyperthyroidism→normal thyroid function→subclinical hypothyroidism), the prevalence of T2 DM combined with NAFLD increased(17.9%→35.0%→55.7%,P<0.01).Logistic regression analysis showed that subclinical hypothyroidism[OR=2.137,95% CI(1.031-4.428),P=0.041] was an in dependent factor for NAFLD in T2 DM patients,while subclinical hyperthyroidism was not an independent risk factor for T2 DM with NAFLD [OR=0.914,95% CI(0.679-1.231),

关 键 词：2型糖尿病 非酒精性脂肪性肝病 亚临床甲状腺功能减退症 亚临床甲状腺功能亢进症 甲状腺激素 

分 类 号：R589[医药卫生—内分泌]