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投稿时间：2020-10-16 网络发布日期：2021-07-20
投稿时间：2020-10-16 网络发布日期：2021-07-20
中文摘要: 目的探讨游离三碘甲状腺原氨酸(FT3)及游离甲状腺素(FT4)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、FT3、FT4、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、FT3、FT3/FT4、TSH水平均高于对照组(P<0.05,P<0.01);经混杂因素校正后,FT3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FT3/FT4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FT3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。
中文关键词: :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
Abstract:Objective To explore the correlation between thyroid hormone levels and type 2 diabetes (T2DM) combined with non alcoholic fatty liver disease(NAFLD) when free triiodothyronine (FT3) and free thyroxine (FT4) were within the normal reference range.
Methods A retrospective study was conducted in 149 T2DM patients.The patients were divided into T2DM with NAFLD group (NAFLD group,n=60) and simple T2DM 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),FT3,FT4 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 T2DM 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),FT3,FT3/FT4 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 FT3 and TSH were still risk factors for T2DM 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 FT3 /FT4 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 T2DM 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 T2DM patients,while subclinical hyperthyroidism was not an independent risk factor for T2DM with NAFLD ［OR=0.914,95% CI(0.679-1.231),P=0.064］.
Conclusions FT3 and TSH are closely associated with NAFLD,and subclinical hypothyroidism may be an independent risk factor for T2DM with NAFLD.
keywords: Type 2 diabetes mellitus Non alcoholic fatty liver disease Subclinical hypothyroidism Subclinical hyperthyroidism Thyroid hormones
文章编号： 中图分类号：R589 文献标志码：A
基金项目:吉林省自然科学基金(20200201587JC)
| Author Name | Affiliation |
| 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 |
引用文本：
崔琦,关宝杰,管圆圆,隋晓婵,周虹,胡晓姣,张帅.亚临床甲状腺功能异常与2型糖尿病合并NAFLD的关系[J].中国临床研究,2021,34(7):872-876.
崔琦,关宝杰,管圆圆,隋晓婵,周虹,胡晓姣,张帅.亚临床甲状腺功能异常与2型糖尿病合并NAFLD的关系[J].中国临床研究,2021,34(7):872-876.