Low Thyroid Function in Nonalcoholic Fatty Liver Disease Is an Independent Predictor of All-Cause and Cardiovascular Mortality
Low Thyroid Function in Nonalcoholic Fatty Liver Disease Is an Independent Predictor of All-Cause and Cardiovascular Mortality
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DOI：
10.14309/ajg.0000000000000654
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发表时间：
2020-09-01
影响因子：
9.8
通讯作者：
Ahmed, Aijaz
中科院分区：
文献类型：
--
作者：
Kim, Donghee;Vazquez-Montesino, Luis Miguel;Ahmed, Aijaz
简介：甲状腺功能正常状态下较高水平的促甲状腺激素（TSH）会对代谢健康产生负面影响，包括非酒精性脂肪肝（NAFLD）。我们研究了在甲状腺激素正常水平的情况下，TSH水平对NAFLD状态分层的全因和特定原因死亡率的影响：使用了1988年至1994年的国家健康和营养检查调查（NHANES）III和2015年的NHANES III相关死亡率数据。NAFLD定义为超声诊断的肝脂肪变性，无并存肝脏疾病。亚临床甲状腺功能减退症定义为TSH水平超过4.5 mIU/L，“低正常”甲状腺功能定义为甲状腺功能正常参考范围内较高的TSH水平（2.5-4.5 mIU/L）。考克斯比例风险模型分析的全因死亡率和原因特异性mortals.Results：在多变量Logistic回归分析，甲状腺功能低下的个人表现出与NAFLD的剂量依赖性的方式。在中位随访23年期间，仅在单变量模型中，甲状腺功能低下与全因死亡率增加相关。甲状腺功能低下与NAFLD患者的全因死亡风险较高相关，而与非NAFLD患者无关。此外，甲状腺功能低下与心血管死亡率在整个人口中的风险较高，其中与NAFLD，但没有表现出与non-NAFLD group.Discussion：在这个大的全国代表性样本的美国成年人，甲状腺功能低下与NAFLD和预测的风险较高的全因和心血管死亡率在个人与NAFLD。
INTRODUCTION: Higher levels of thyroid-stimulating hormone (TSH) in the euthyroid state can negatively affect the metabolic health, including nonalcoholic fatty liver disease (NAFLD). We studied the effect of TSH levels in the setting of normal levels of thyroid hormone on all-cause and cause-specific mortality stratified by NAFLD status.METHODS: The National Health and Nutrition Examination Survey (NHANES) III from 1988 to 1994 and NHANES III-linked mortality data through 2015 were used. NAFLD was defined as ultrasonographically diagnosed hepatic steatosis without coexisting liver diseases. Subclinical hypothyroidism was defined as a TSH level over 4.5 mIU/L and "low-normal" thyroid function as higher TSH level (2.5-4.5 mIU/L) within the euthyroid reference range. The Cox proportional hazard model analyzed the all-cause mortality and cause-specific mortality.RESULTS: In a multivariate logistic regression analysis, individuals with low thyroid function demonstrated an association with NAFLD in a dose-dependent manner. During a median follow-up of 23 years, low thyroid function was associated with increased all-cause mortality only in the univariate model. Low thyroid function was associated with a higher risk for all-cause mortality in individuals with NAFLD and not in those without NAFLD. Furthermore, low thyroid function was associated with a higher risk for cardiovascular mortality in the entire population and among those with NAFLD but demonstrated no association with the non-NAFLD group.DISCUSSION:In this large nationally representative sample of American adults, low thyroid function was associated with NAFLD and a predictor of higher risk for all-cause and cardiovascular mortality in individuals with NAFLD.