甲状腺功能正常的2型糖尿病患者血清甲状腺激素水平与非酒精性脂肪性肝病的关系  

Relationship between serum thyroid hormone levels and non-alcoholic fatty liver disease in type 2 diabetes mellitus patients with normal thyroid function

作　　者：冷鹏 高明[2] 王雪鹰[2] LENG Peng;GAO Ming;WANG Xueying(Graduate Training Base,Jinzhou Medical University,Dandong Central Hospital,Dandong 118000,CHINA)

机构地区：[1]锦州医科大学丹东市中心医院研究生培养基地,辽宁丹东118000 [2]锦州市中心医院内分泌科

出　　处：《江苏医药》2023年第3期238-242,共5页Jiangsu Medical Journal

基　　金：辽宁省自然科学基金(2021-MS-380)。

摘　　要：目的探讨甲状腺功能正常的2型糖尿病(T2DM)患者血清甲状腺激素水平与非酒精性脂肪性肝病(NAFLD)的关系。方法200例甲状腺功能正常的T2DM患者中,合并NAFLD 100例(NAFLD组),未合并NAFLD 100例(非NAFLD组)。比较两组相关临床资料。采用logistic回归分析甲状腺功能正常的T2DM患者合并NAFLD的影响因素,绘制ROC曲线分析FT_(3)对合并NAFLD的诊断价值。结果与非NAFLD组比较,NAFLD组年龄较小,T2DM病程较短,血清HDL-C、BUN水平较低,体重、BMI、DBP、空腹C肽、空腹胰岛素、TG、ALT、AST、γ谷氨酰转肽酶、尿酸、FT_(3)水平较高(P<0.05)。BMI、TG、AST和FT_(3)水平较高是甲状腺功能正常的T2DM患者合并NAFLD的独立危险因素(P<0.05)。FT_(3)诊断甲状腺功能正常的T2DM患者合并NAFLD的AUC为0.773[95%CI(0.709~0.837),P<0.01],当FT_(3)取最佳诊断界值为4.74 pmol/L时,诊断的灵敏度为64%,特异度为79%。FT_(3)联合AST诊断甲状腺功能正常的T2DM患者合并NAFLD的AUC为0.810[95%CI(0.750~0.870),P<0.01],诊断价值最高。结论对于甲状腺功能正常的T2DM患者,血清FT_(3)水平与NAFLD的发生有关,FT_(3)联合AST有较高的诊断价值。Objective To investigate the relationship between serum thyroid hormone levels and non-alcoholic fatty liver disease(NAFLD)in type 2 diabetes mellitus(T2DM)patients with normal thyroid function.Methods Two hundred T2DM patients with normal thyroid function were divided into NAFLD group(100 cases)and non-NAFLD group(100 cases).The relevant clinical data were compared between the two groups.The influencing factors for NAFLD in T2DM patients with normal thyroid function were analyzed by logistic regression analysis.The diagnostic value of FT_(3)was analyzed by ROC curve.Results Compared to non-NAFLD group,the age was younger,T2DM course was shorter,the levels of HDL-C and BUN were lower,and weight,BMI,DBP,fasting C-peptide,fasting insulin,TG,ALT,AST,γ-glutamyl transpeptidase,uric acid and FT_(3)were higher in NAFLD group(P<0.05).Higher BMI,TG,AST and FT_(3)were the independent risk factors for NAFLD in T2DM patients with normal thyroid function(P<0.05).The AUC of FT_(3)in the diagnosis of NAFLD in T2DM patients with normal thyroid function was 0.773[95%CI(0.709-0.837),P<0.01].When taking FT_(3)4.74 pmol/L as the cut-off value,the diagnostic sensitivity and specificity were 64%and 79%,respectively.The AUC of FT_(3)combined with AST in the diagnosis of NAFLD in T2DM patients with normal thyroid function was 0.810[95%CI(0.750-0.870),P<0.01],the diagnostic value of which was the highest.Conclusion Serum FT_(3)level is associated with the occurrence of NAFLD in T2DM patients with normal thyroid function,and FT_(3)combined with AST has high diagnostic value.

关 键 词：2型糖尿病 非酒精性脂肪性肝病 甲状腺激素 

分 类 号：R587[医药卫生—内分泌]