2型糖尿病患者非酒精性脂肪肝与内脏脂肪面积及甲状腺结节的相关性研究  

The Correlation of Non-alcoholic Fatty Liver Disease with Visceral Fat Area and Thyroid Nodules in Patients with Type 2 Diabetes Mellitus

作　　者：曾佳玲 蒙艳[1] 邓婷婷[1] 李锦华[1] 赵萍[1] ZENG Jialing;MENG Yan;DENG Tingting;LI Jinhua;ZHAO Ping(Department of Endocrinology,the Fourth Affiliated Hospital of Guangxi Medical University/Liuzhou Worker's Hospital,Liuzhou 545000,China)

机构地区：[1]广西医科大学第四附属医院、柳州市工人医院内分泌科,广西壮族自治区柳州市545000

出　　处：《中国全科医学》2025年第9期1072-1083,共12页Chinese General Practice

基　　金：广西壮族自治区卫生健康委员会自筹经费科研课题(Z20200520)。

摘　　要：背景非酒精性脂肪肝(NAFLD)在2型糖尿病(T2DM)患者中患病率明显升高,目前关于T2DM中NAFLD与内脏脂肪面积(VFA)及甲状腺结节的相关研究鲜有报道。目的 探讨T2DM患者发生NAFLD的相关因素及NAFLD与VFA、甲状腺结节及甲状腺功能的相关性。方法 回顾性选择2018年1月—2023年4月在广西医科大学第四附属医院(柳州市工人医院)内分泌科住院的T2DM患者为研究对象,依据腹部彩超结果将研究对象分为NAFLD组及非NAFLD组,比较两组的一般资料,VFA、腹部皮下脂肪面积(SFA)、胰岛素功能、甲状腺功能、甲状腺结节患病率、血糖、血脂、肝肾功能水平等指标的差异。依据VFA将研究对象分为内脏性肥胖组(VFA≥100 cm^(2))和非内脏性肥胖组(VFA<100 cm^(2)),比较两组年龄、性别、NAFLD及甲状腺结节患病率的差异。使用Spearman秩相关分析探讨NAFLD、VFA的相关因素及两者与甲状腺结节的相关性分析,同时探讨甲状腺结节面积大小的相关因素。采用二元Logistic回归分析明确T2DM患者NAFLD及甲状腺结节发生的危险因素。采用受试者工作特征(ROC)曲线评估BMI、腰臀围、腰臀比、VFA、胰岛素抵抗指数(HOMA-IR)对T2DM患者发生NAFLD的预测价值及最佳截断值。结果 本研究共纳入578例T2DM患者,NAFLD组293例,NAFLD患病率50.69%,非NAFLD组285例。NAFLD组年龄小于非NAFLD组[(57.0±12.8)岁与(59.3±11.6)岁,P<0.05],NAFLD组体质量、BMI、腰围、臀围、VFA、SFA、糖化血红蛋白(HbA_(1c))、空腹胰岛素(FINS)、空腹C肽(FCP)、HOMA-IR、胰岛素分泌指数(HOMA-β)、游离三碘甲状腺原氨酸(FT_(3))、血尿酸(SUA)、总胆固醇(TC)、三酰甘油(TG)、C反应蛋白(CRP)均高于非NAFLD组,但其血肌酐(SCr)水平低于非NAFLD组(P<0.05)。内脏性肥胖组251例,非内脏性肥胖组327例,内脏性肥胖组年龄小于非内脏性肥胖组[(55.3±13.4)岁与(60.3±10.8)岁,P<0.05]。内脏性肥胖组患者NAFLD发生率高于非Background The prevalence of non-alcoholic fatty liver disease(NAFLD)significantly increases in patients with type 2 diabetes mellitus(T2DM).However,the correlation of NAFLD with visceral fat area(VFA)and thyroid nodules in T2DM patients has been rarely reported.Objective This study aims to investigate the influencing factors for NAFLD in T2DM patients,and the correlation of NAFLD with VFA,thyroid nodules,and thyroid function in this population.Methods Hospitalized T2DM patients in the Department of Endocrinology,the Fourth Affiliated Hospital of Guangxi Medical University(Liuzhou Worker's Hospital)from January 2018 to April 2023 were retrospectively recruited.They were divided into two groups based on abdominal ultrasound findings:NAFLD group and non-NAFLD group.General data,including VFA,subcutaneous fat area(SFA),insulin function,thyroid function,prevalence of thyroid nodules,blood glucose levels,lipid levels,and liver and kidney function were compared between the two groups.Additionally,patients were divided into visceral obesity group(VFA≥100 cm^(2))and non-visceral obesity group(VFA<100 cm^(2))based on VFA.Age,sex,prevalence of NAFLD and thyroid nodule were compared between the two groups.Spearman correlation analyses were employed to investigate factors associated with NAFLD and VFA,as well as their correlation with thyroid nodules.Influencing factors for the volume of thyroid nodules were explored as well.Furthermore,binary Logistic regression analysis was used to determine risk factors for both NAFLD and thyroid nodules in T2DM patients.Receiver operating characteristic(ROC)curve analysis evaluated the predictive value of BMI,waist-hip circumference,and waist-hip ratio,VFA,homeostatic model assessment for insulin resistance(HOMA-IR)in predicting NAFLD in T2DM patients and their optimal cut-off values.Results A total of 578 T2DM patients were enrolled in this study,including 293(50.69%)patients in the NAFLD group and 285 in the non-NAFLD group.The age of the NAFLD group was significantly lower than that

关 键 词：糖尿病 2型 非酒精性脂肪性肝病 内脏脂肪 甲状腺疾病 甲状腺结节 胰岛素抵抗 

分 类 号：R578.1[医药卫生—消化系统]