垂体功能减退症患者非酒精性脂肪性肝病发生情况及其相关激素水平变化

Will the hypopituitarism lead to the occurrence of nonalcoholic fatty liver diseases?An preliminary study

目的探讨垂体功能减退症(HP)患者合并非酒精性脂肪性肝病(NAFLD)情况及其血清游离甲状腺素(FT_(4))水平和FT_(3)/FT_(4)比值变化,以探讨甲状腺功能与NAFLD发生之间的关系。方法2018年1月~2022年6月我院诊治的HP患者32例和NAFLD患者30例,使用超声行腹部检查。采用ELISA法检测血清游离三碘甲状腺原氨酸(FT_(3))、FT_(4)、促甲状腺激素(TSH)、促肾上腺皮质激素(ACTH)、皮质醇(Cor)、生长激素(GH)和胰岛素样生长因子-1(IGF-1)。结果在本组32例HP患者中,经超声检查诊断合并NAFLD者17例;HP合并NAFLD组体质指数、血清ALT、AST、GGT、LDH和TG水平分别为(27.4±3.6)kg/m^(2)、76.7(36.3,328.6)U/L、65.2(38.5,335.2)U/L、68.5(32.2,82.5)U/L、(313.5±55.3)U/L和(2.1±0.7)mmol/L,均显著高于HP组【分别为(23.4±1.5)kg/m^(2)、16.2(10.4,23.6)U/L、18.1(14.5,25.9)U/L、36.0(12.5,43.5)U/L、(198.1±47.3)U/L和(1.3±1.2)mmol/L,P<0.05】,而血清HDL水平为(0.8±0.6)mmol/L,显著低于HP组【(1.2±0.5)mmol/L,P<0.05】;HP合并NAFLD组血清FT_(4)和GH水平分别为9.4(7.3,12.7)pmol/L和0.05(0.04,0.10)ng/mL,显著低于HP组【分别为12.3(8.8,15.3)pmol/L和0.1(0.05,0.2)ng/mL,P<0.05】,而血清FT_(3)/FT_(4)比值为0.4(0.3,0.4),显著大于HP组【0.2(0.2,0.4),P<0.05】,血清TSH、FT_(4)和GH水平分别为1.3(0.4,3.3)μIU/mL、9.4(7.3,12.7)pmol/L和0.05(0.04,0.10)ng/mL,显著低于NAFLD组【分别为2.8(1.4,4.5)μIU/mL、16.5(11.6,24.9)pmol/L和0.1(0.05,0.3)ng/mL,P<0.05】,而血清FT_(3)/FT_(4)比值显著大于NAFLD组【0.2(0.1,0.3),P<0.05】。结论垂体功能减退可能通过改变全身激素水平而影响脂质代谢,导致NAFLD的发生。

Objective This study aimed to the prevalence of non-alcoholic fatty liver diseases(NAFLD)in patients with hypopituitarism(HP),and to clarify the relationship between thyroid functions and the occurrence of NAFLD.Methods 32 patients with HP and 30 patients with NAFLD were enrolled in our hospital between January 2018 and June 2022,and all underwent ultrasonography to determine the diagnosis of NAFLD.Serum free triiodothyronine(FT_(3)),free thyroxine(FT_(4)),thyroid-stimulating hormone(TSH),adrenocorticotrophic hormone(ACTH),cortisol(Cor),growth hormone(GH)and insulin-like growth factor-1(IGF-1)were detected by ELISA.Results Out of 32 patients with HP in our series,the ultrasonography revealed NAFLD in 17 cases;the body mass index,serum ALT,AST,GGT,lactate dehydrogenase and triglyceride levels in patients with HP and NAFLD were(27.4±3.6)kg/m^(2),76.7(36.3,328.6)U/L,65.2(38.5,335.2)U/L,68.5(32.2,82.5)U/L,(313.5±55.3)U/L and(2.1±0.7)mmol/L,all significantly higher than[(23.4±1.5)kg/m^(2),16.2(10.4,23.6)U/L,18.1(14.5,25.9)U/L,36.0(12.5,43.5)U/L,(198.1±47.3)U/L and(1.3±1.2)mmol/L,respectively,P<0.05],while serum high-density lipoprotein level was(0.8±0.6)mmol/L,much lower than[(1.2±0.5)mmol/L,P<0.05]in patients with HP;serum FT_(4) and GH levels in patients with HP and NAFLD were 9.4(7.3,12.7)pmol/L and 0.05(0.04,0.10)ng/mL,much lower than[12.3(8.8,15.3)pmol/L and 0.1(0.05,0.2)ng/mL,P<0.05]in patients with HP,while the FT_(3)/FT_(4) ratio was 0.4(0.3,0.4),much greater than[0.2(0.2,0.4),P<0.05]in patients with HP;serum TSH,FT_(4) and GH levels were 1.3(0.4,3.3)μIU/mL,9.4(7.3,12.7)pmol/L and 0.05(0.04,0.10)ng/mL,significantly lower than[2.8(1.4,4.5)μIU/mL,16.5(11.6,24.9)pmol/L and 0.1(0.05,0.3)ng/mL,P<0.05],while the FT_(3)/FT_(4) ratio was significantly greater than[0.2(0.1,0.3),P<0.05]in patients with NAFLD.Conclusion The hypothyroidism could disturb systemic lipid metabolism,which might lead to the occurrence of NAFLD.