High-Normal Serum Thyrotropin Levels Increased the Risk of Non-Alcoholic Fatty Liver Disease in Euthyroid Subjects with Type 2 Diabetes.
High-Normal Serum Thyrotropin Levels Increased the Risk of Non-Alcoholic Fatty Liver Disease in Euthyroid Subjects with Type 2 Diabetes.
复制标题
正常高血清促甲状腺素水平会增加甲状腺功能正常的 2 型糖尿病患者患非酒精性脂肪肝的风险
DOI：
10.2147/dmso.s313224
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发表时间：
2021
期刊：
影响因子：
--
通讯作者：
Chen Y
中科院分区：
文献类型：
--
作者：
Tan Y;Tang X;Mu P;Yang Y;Li M;Nie Y;Li H;Zhu Y;Chen Y
目的本研究的目的是探讨甲状腺功能正常的T2 DM患者中高正常促甲状腺激素（TSH）水平与非酒精性脂肪性肝病（NAFLD）患病率之间的关系。方法2016年1月至2018年12月在中山大学附属第三医院进行的这项横断面研究共纳入2289例甲状腺功能正常的T2 DM成人。经腹部超声诊断为NAFLD。分析甲状腺功能参数，包括TSH、游离三碘甲状腺原氨酸（FT 3）和游离甲状腺素（FT 4）水平。按TSH水平的四分位数（Q1-4）对患者进行分层。多变量逻辑回归模型用于评估甲状腺功能正常的T2 DM成人中TSH水平四分位数与NAFLD风险之间的相关性。结果940例甲状腺功能正常的2型糖尿病患者被诊断为NAFLD。根据甲状腺功能参数四分位数对受试者进行分组。NAFLD患病率随TSH水平四分位数的增加而增加（Q1 ~ Q4：34.8%、37.5%、44.9%和47.0%，P<0.01），但与FT 3或FT 4水平四分位数的增加无关。在多变量logistic回归模型中，与最低TSH水平四分位数（Q1）相比，最高TSH水平四分位数（Q4）（OR=1.610，95%CI =1.131-2.289，P=0.008）与甲状腺功能正常的T2 DM成人患者NAFLD风险增加独立相关。根据糖化血红蛋白（HbA 1c）水平和体重指数（BMI）进行额外分层后，在HbA 1c水平≥7%或BMI<28 kg/m2的甲状腺功能正常的T2 DM患者中，最高TSH水平四分位数仍与NAFLD风险增加独立相关。结论甲状腺功能正常的T2 DM患者血清TSH水平升高与NAFLD的发生密切相关，这为NAFLD的治疗提供了新的思路。
Purpose The aim of this study was to investigate the association between high-normal thyrotropin (TSH) levels and the prevalence of non-alcoholic fatty liver disease (NAFLD) in euthyroid patients with T2DM. Methods A total of 2289 euthyroid adults with T2DM were included in this cross-sectional study conducted at the Third Affiliated Hospital of Sun Yat-sen University from January 2016 to December 2018. NAFLD was diagnosed by abdominal ultrasound. Thyroid function parameters, including the levels of TSH, free triiodothyronine (FT3) and free thyroxine (FT4), were analyzed. The patients were stratified by quartiles (Q1-4) of TSH levels. Multivariate logistic regression models were used to evaluate the association between the quartiles of TSH levels and the risk of NAFLD in euthyroid adults with T2DM. Results There were 940 (41.1%) euthyroid adults with T2DM who were diagnosed with NAFLD. The subjects were divided according to the thyroid function parameter quartiles. The prevalence of NAFLD increased with increasing TSH level quartiles (Q1 to Q4: 34.8%, 37.5%, 44.9% and 47.0%, P<0.01) but not with increasing FT3 or FT4 level quartiles. In the multivariate logistic regression model, compared with the lowest TSH level quartile (Q1), the highest TSH level quartile (Q4) (OR=1.610, 95% CI=1.131–2.289, P=0.008) was independently associated with an increased risk of NAFLD in euthyroid adults with T2DM after adjusting for multiple confounders. After additional stratification by the level of glycosylated haemoglobin (HbA1c) and body mass index (BMI), the highest TSH level quartile was still independently associated with an increased risk of NAFLD in euthyroid patients with T2DM who had an HbA1c level≥7% or a BMI<28 kg/m2. Conclusion High-normal serum TSH levels are significantly associated with the presence of NAFLD in T2DM patients with euthyroid function, which provide novel insight for treating NAFLD.