甲状腺功能正常的2型糖尿病患者促甲状腺激素与代谢相关性脂肪肝的相关性研究

Correlation between throid stimulating hormone and metabolic associated fatty liver disease in type 2 diabetes patients with normal thyroid function

目的研究甲状腺功能正常的2型糖尿病(T2DM)患者促甲状腺激素(TSH)水平与代谢相关脂肪性肝病(MAFLD)的相关性。方法回顾分析我院内分泌科收治的甲状腺功能正常的T2DM患者1888例,根据是否合并MAFLD将其分为MAFLD组(1150例)和无MAFLD组(738例);依据TSH水平将所有患者进行四分位数分组(Q1~Q4组)。收集所有患者一般临床资料资料[年龄、性别、病程、BMI、腰围、MAFLD患病率、收缩压(SBP)和舒张压(DBP)]与实验室检查结果[ALT、AST、空腹葡萄糖(FPG)、血肌酐(SCr)、甘油三酯(TG)、总胆固醇(TC)、低密度脂蛋白胆固醇(LDL-C)、高密度脂蛋白胆固醇(HDL-C)、糖化血红蛋白(HbA1c)、游离三碘甲状腺原氨酸(FT3)、游离甲状腺素(FT_(4))、促甲状腺素(TSH)]并分组比较;采用多因素logistic回归分析评估甲状腺功能正常T2DM患者发生MAFLD的相关因素。结果MAFLD患病率为60.91%。MAFLD组BMI、腰围、ALT、AST、TG、LDL-C、TSH水平均显著高于无MAFLD组,FT3、FT_(4)及HDL-C水平均显著低于无MAFLD组(P<0.05)。Q1、Q2、Q3、Q4组MAFLD患病率依次升高;组间比较BMI、腰围、TG、HDL-C、FT_(4)水平差异有统计学意义(P<0.05)。多因素logistic回归分析结果显示,腰围、TG、TSH均是甲状腺功能正常T2DM患者发生MAFLD的独立危险因素,HDL-C是其保护因素(P<0.05)。结论甲状腺功能正常的T2DM患者TSH水平升高与MAFLD患病率相关。

Objective To investigate the correlation between throid stimulating hormone(TSH)and metabolic associated fatty liver disease(MAFLD)in type 2 diabetes mellitus(T2DM)with normal thyroid.Methods Retrospectively analyze 1888 T2DM patients with normal thyroid function admitted to the department of endocrinology of our hospital.According to whether they were combined with MAFLD or not,they were divided into MAFLD group(1150 cases)and non-MAFLD group(738 cases).All patients were quartile divided into four groups according to their TSH levels(Q1~Q4 group).General clinical data[age,sex,course of disease,BMI,waistline,prevalence of MAFLD,systolic blood pressure(SBP)and diastolic blood pressure(DBP)]and laboratory results[ALT,AST,fasting glucose(FPG),blood creatinine(SCr),triglyceride(TG),total cholesterol(TC),and low density lipoprotein bile cholesterol(LDL-C),high density lipoprotein cholesterol(HDL-C),glycated hemoglobin(HbA1c),free triiodothyronine(FT_(3)),free thyroxine(FT_(4)),thyrotropin(TSH)]were compared and grouped.Multivariate logistic regression analysis was used to evaluate the risk factors of MAFLD in T2DM patients with normal thyroid function.Results The prevalence of MAFLD was 60.91%.BMI,waistline,the levels of ALT,AST,TG,LDL-C and TSH in MAFLD group were significantly higher than those in non-MAFLD group and the levels of FT_(3),FT_(4),and HDL-C were significantly lower than those in non-MAFLD group(P<0.05).The prevalence of MAFLD in Q1,Q2,Q3 and Q4 groups increased in turn.There were significant differences in BMI,waistline,TG,HDL-C and FT_(4)levels between the two groups(P<0.05).The logistic regression analysis showed that waistline,TG and TSH were independent risk factors for MAFLD in T2DM patients with normal thyroid function,and HDL-C was its protective factor.Conclusion TSH level elevating was significantly associated with the presence of MAFLD in T2DM patients with normal thyroid function.