甲状腺功能正常的2型糖尿病患者甲状腺激素敏感性与非酒精性脂肪肝的相关性

doi:10.3969/j.issn.1004-583X.2025.02.006

摘要/Abstract

摘要：

目的分析甲状腺功能正常的2型糖尿病患者甲状腺激素敏感性指标与非酒精性脂肪肝(non-alcoholic fatty liver disease,NAFLD)的相关性。方法采取横断面研究,回顾性分析2023年12月-2024年5月于郑州大学第五附属医院内分泌科住院的甲状腺功能正常的2型糖尿病(type 2 diabetes mellitus,T2DM)患者330例,依据是否合并NAFLD分为NAFLD组(n=112)和非NAFLD组(n=218)。所有患者均完善腹部超声、血生化、内脏脂肪面积(visceral fat area,VFA)、腹部皮下脂肪面积(subcutaneous fat area, SFA)等检查。探讨甲状腺反馈分位数指数(thyroid feedback quantile-based index, TFQI)、促甲状腺激素甲状腺素抵抗指数(thyrotoph thyroxine resistance index, TT4RI)、促甲状腺激素指数(TSHI)、游离三碘甲腺原氨酸/游离甲状腺素(FT3/FT4)与NAFLD的相关性。结果与非NFALD组比较,NAFLD组吸烟比例、体重、体重指数、VFA、SFA、收缩压、舒张压、空腹血糖(fasting plasma glucose, FPG)、糖化血红蛋白(glycosylated hemoglobin, HbA₁c)、总胆固醇(total cholestero,TC)、甘油三酯(triglyceride,TG)、低密度脂蛋白胆固醇(low density lipoprotein cholesterol,LDL-C)、FT3、TFQI和FT3/FT4水平均较高 (P<0.05),高密度脂蛋白胆固醇(high density lipoprotein cholesterol,HDL-C)水平较低(P<0.05)。Spearman相关分析提示,TFQI与TG、LDL-C呈正相关(P<0.05), 与HDL-C呈负相关(P<0.05);TT4RI与TC、TG、FPG、HbA₁c呈正相关(P<0.05);TSHI与TC、TG、FPG、HbA₁c呈正相关(P<0.05);FT3/FT4与TC、TG、LDL-C、FPG、HbA₁c呈正相关。多因素logistic回归分析显示,TG、VFA、HbA₁c、FT3/FT4是T2DM患者合并NAFLD的独立危险因素(P<0.01)。绘制受试者工作特征曲线发现,FT3/FT4 评估T2DM患者合并NAFLD的曲线下面积为0.679,敏感度、特异度分别为70.47%、65.09%。结论甲状腺功能正常T2DM患者FT3/FT4升高与NAFLD风险增加相关。

关键词: 糖尿病,2型, 非酒精性脂肪性肝病, 甲状腺激素类, 甲状腺激素敏感性

Abstract:

Objective To analyze the correlation between thyroid hormone sensitivity and non-alcoholic fatty liver disease (NAFLD) in type 2 diabetes mellitus (T2DM) patients with normal thyroid function. Methods This was a cross-sectional study. A retrospective analysis was performed to assess 330 T2DM patients with normal thyroid function who were hospitalized in the Department of Endocrinology, the Fifth Affiliated Hospital of Zhengzhou University from December 2023 to May 2024. According to the presence or absence of NAFLD, the patients were divided into NAFLD group (n=112) and non-NAFLD group (n=218). All patients underwent examinations like abdominal ultrasound, blood biochemistry, visceral fat area (VFA), and abdominal subcutaneous fat area (SFA). The correlations between the thyroid feedback quantile-based Index (TFQI), thyrotroph thyroxine resistance index (TT4RI), thyroid-stimulating hormone index (TSHI), free triiodothyronine/free thyroxine (FT3/FT4) with NAFLD were explored. Results Compared with non-NAFLD group, in NAFLD group had significantly higher proportions of smokers, and higher levels of body weight, body mass index, VFA, SFA, systolic/ diastolic blood pressure, fasting plasma glucose (FPG), glycosylated hemoglobin (HbA₁c), total cholesterol (TC), triglyceride (TG), low density lipoprotein cholesterol (LDL-C), FT3, TFQI, and FT3/FT4 (P<0.05), and significantly lower level of high density lipoprotein cholesterol (HDL-C) (P<0.05). Spearman correlation analysis showed that TFQI was positively correlated with TG and LDL-C (P<0.05), and negatively correlated with HDL-C (P<0.05). TT4RI was positively correlated with TC, TG, FPG, and HbA₁c (P<0.05). TSHI was positively correlated with TC, TG, FPG, and HbA₁c (P<0.05). FT3/FT4 was positively correlated with TC, TG, LDL-C, FPG, and HbA₁c. Multivariate logistic regression analysis showed that TG, VFA, HbA₁c, and FT3/FT4 were independent risk factors for the occurrence of NAFLD in T2DM patients (P<0.01). By drawing the receiver operating characteristic curve, it was found that the area under the curve of FT3/FT4 for evaluating NAFLD in T2DM patients was 0.679, with a sensitivity of 70.47% and a specificity of 65.09%. Conclusion An increase in FT3/FT4 in T2DM patients with normal thyroid function is associated with an increased risk of NAFLD.

Key words: diabetes mellitus, type 2, non-alcoholic fatty liver disease, thyroid hormones, thyroid hormone sensitivity

中图分类号:

R587.1

史双伟, 饶小娟, 解丽然, 方一凡, 王姗姗. 甲状腺功能正常的2型糖尿病患者甲状腺激素敏感性与非酒精性脂肪肝的相关性[J]. 临床荟萃, 2025, 40(2): 133-137.

Shi Shuangwei, Rao Xiaojuan, Xie Liran, Fang Yifan, Wang Shanshan. Correlation between thyroid hormone sensitivity and non-alcoholic fatty liver in type 2 diabetes mellitus patients with normal thyroid function[J]. Clinical Focus, 2025, 40(2): 133-137.

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参考文献 20

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组别	例数	男性 [例(%)]		年龄 (岁)		吸烟史 [例(%)]		糖尿病病程 (年)	身高 (cm)
非NAFLD组	218	121(55.5)		54.24±6.31		54(24.8)		13.24±3.82	167.60±2.74
NAFLD组	112	61(54.5)		52.60±4.73		32(28.6)		12.09±4.28	168.02±5.28
t/χ²值		0.434		0.612		2.034		0.732	0.719
P值		0.502		0.409		0.031		0.315	0.321
组别	体重(kg)		BMI(kg/m²)		VFA(cm²)		SFA(cm²)	收缩压(mmHg)	舒张压(mmHg)
非NAFLD组	67.60±8.20		22.09±3.48		93.94±12.75		164.75±17.20	123(102, 145)	67(56, 83)
NAFLD组	74.03±4.29		27.04±5.25		123.05±17.39		234.04±21.47	143(127, 157)	92(73, 103)
t/Z值	1.204		2.044		3.173		4.923	1.045	0.983
P值	0.000		0.000		0.000		0.000	0.015	0.026

组别	例数	男性 [例(%)]		年龄 (岁)		吸烟史 [例(%)]		糖尿病病程 (年)	身高 (cm)
非NAFLD组	218	121(55.5)		54.24±6.31		54(24.8)		13.24±3.82	167.60±2.74
NAFLD组	112	61(54.5)		52.60±4.73		32(28.6)		12.09±4.28	168.02±5.28
t/χ²值		0.434		0.612		2.034		0.732	0.719
P值		0.502		0.409		0.031		0.315	0.321
组别	体重(kg)		BMI(kg/m²)		VFA(cm²)		SFA(cm²)	收缩压(mmHg)	舒张压(mmHg)
非NAFLD组	67.60±8.20		22.09±3.48		93.94±12.75		164.75±17.20	123(102, 145)	67(56, 83)
NAFLD组	74.03±4.29		27.04±5.25		123.05±17.39		234.04±21.47	143(127, 157)	92(73, 103)
t/Z值	1.204		2.044		3.173		4.923	1.045	0.983
P值	0.000		0.000		0.000		0.000	0.015	0.026

组别	例数	FPG (mmol/L)		HbA₁c (%)		TC (mmol/L)	TG (mmol/L)	HDL-C (mmol/L)		LDL-C (mmol/L)		FT3 (pmol/L)
非NAFLD组	218	6.02±0.29		6.71±0.03		4.62±0.63	1.07±0.21	1.46±0.23		2.96±0.27		4.28±0.19
NAFLD组	112	6.94±1.03		7.42±0.24		5.07±0.38	1.46±0.17	1.17±0.37		3.14±0.30		4.56±0.24
t值		2.731		1.983		1.834	2.381	3.401		4.903		0.891
P值		0.000		0.001		0.013	0.000	0.000		0.000		0.032
组别	FT4 (pmol/L)		TSH (mU/L)		TFQI		TT4RI		TSHI		FT3/FT4
非NAFLD组	13.45±0.35		1.85±0.35		-0.02(-0.31, 0.27)		26.53(21.54, 35.34)		2.07(0.68, 1.72)		0.32(0.17, 0.42)
NAFLD组	13.62±0.25		1.90±0.41		0.02(-0.19, 0.31)		27.45(22.27, 34.62)		1.98(0.62, 1.65)		0.34(0.19, 0.41)
t/Z值	0.136		0.472		1.389		0.372		0.419		3.274
P值	0.732		0.082		0.029		0.062		0.073		0.000

组别	例数	FPG (mmol/L)		HbA₁c (%)		TC (mmol/L)	TG (mmol/L)	HDL-C (mmol/L)		LDL-C (mmol/L)		FT3 (pmol/L)
非NAFLD组	218	6.02±0.29		6.71±0.03		4.62±0.63	1.07±0.21	1.46±0.23		2.96±0.27		4.28±0.19
NAFLD组	112	6.94±1.03		7.42±0.24		5.07±0.38	1.46±0.17	1.17±0.37		3.14±0.30		4.56±0.24
t值		2.731		1.983		1.834	2.381	3.401		4.903		0.891
P值		0.000		0.001		0.013	0.000	0.000		0.000		0.032
组别	FT4 (pmol/L)		TSH (mU/L)		TFQI		TT4RI		TSHI		FT3/FT4
非NAFLD组	13.45±0.35		1.85±0.35		-0.02(-0.31, 0.27)		26.53(21.54, 35.34)		2.07(0.68, 1.72)		0.32(0.17, 0.42)
NAFLD组	13.62±0.25		1.90±0.41		0.02(-0.19, 0.31)		27.45(22.27, 34.62)		1.98(0.62, 1.65)		0.34(0.19, 0.41)
t/Z值	0.136		0.472		1.389		0.372		0.419		3.274
P值	0.732		0.082		0.029		0.062		0.073		0.000

项目		TFQI	TT4RI	TSHI	FT3/FT4
TC	r_s	0.008	0.106	0.137	0.128
	P	0.410	<0.001	<0.001	<0.001
TG	r_s	0.093	0.063	0.017	0.029
	P	<0.001	0.015	0.001	0.004
HDL-C	r_s	-0.084	0.019	0.035	0.034
	P	<0.001	0.062	0.073	0.071
LDL-C	r_s	0.048	0.018	0.090	0.385
	P	<0.01	0.065	0.073	<0.001
FPG	r_s	-0.003	0.025	0.020	0.170
	P	0.769	0.012	0.040	0.002
HbA₁c	r_s	0.040	0.027	0.097	0.445
	P	0.356	0.010	<0.001	<0.001