摘要/Abstract
摘要： 目的·探讨甲状腺功能正常2型糖尿病（type 2 diabetes mellitus，T2DM）患者血清甲状腺激素水平及游离三碘甲状原氨酸（free triiodothyronine，FT3）/ 游离甲状腺素（free thyroxine，FT4）比值与非酒精性脂肪性肝病（non-alcoholic fatty liver disease，NAFLD）的相关性。方法·连续收集2016年2月至2017年7月于上海市第九人民医院内分泌科住院的 T2DM患者的临床资料，排除甲状腺功能异常、其他肝脏疾病和过量饮酒后，共纳入256例T2DM患者。按腹部B超检查结果诊断NAFLD，其中，合并NAFLD患者92例，非NAFLD患者164例。使用R语言中MatchIt函数对2组协变量（年龄、性别、体质量指数）进行1:1匹配。采用线性回归和Logistic回归分析甲状腺激素水平及FT3/FT4比值与NAFLD的相关性。结果·匹配后，合并NAFLD组和非NAFLD组各有92例。组间比较结果显示，FT3、总三碘甲状原氨酸（TT3）、FT3/FT4比值、总胆固醇（TC）、三酰甘油（TAG）、低密度脂蛋白胆固醇（LDL-C）、谷丙转氨酶（GPT）、谷草转氨酶（GOT）和γ-谷氨酰转移酶（γ-GT）水平差异具有统计学意义（均P<0.05）。FT3水平和FT3/FT4比值分别与GPT及GOT水平呈线性正相关（均P<0.05），TT3水平与GPT、GOT及γ-GT水平呈线性正相关（均P<0.05）。Logistic回归分析显示，FT3水平与NAFLD患病风险独立正相关（P0.018）。受试者工作特征（ROC）曲线分析证实，在T2DM患者中，FT3/FT4比值可作为预测NAFLD患病风险的血清学指标（P0.005）。结论·甲状腺功能正常T2DM患者的血清FT3水平及FT3/FT4比值与NAFLD患病风险独立正相关，FT3/FT4比值可有效预测NAFLD患病风险。
关键词: 2型糖尿病, 非酒精性脂肪性肝病, 甲状腺激素
Abstract:
Objective · To investigate the correlation between the levels of serum thyroid hormones or free triiodothyronine/free thyroxine（FT3/FT4） ratio and non-alcoholic fatty liver disease (NAFLD) in euthyroid patients with type 2 diabetes mellitus (T2DM). Methods · The consecutive medical records of inpatients with T2DM were collected at the Department of Endocrinology and Metabolism in Shanghai Ninth Peoples Hospital February 2016 to July 2017. Totally 256 euthyroid T2DM patients were enrolled after excluding subjects with thyroid dysfunction, other liver diseases and excess alcohol consumption. The diagnosis of NAFLD was based on abdominal ultrasonography. Patients were divided into T2DM with NAFLD group (92 cases) and without NAFLD group (164 cases). Matching function in R language was performed for 1:1 match (age, sex and body mass index) between two groups. Multiple linear regression and Logistic regression analyses were used to evaluate the correlation between the levels of thyroid hormones or FT3/ FT4 ratio and NAFLD. Results · There were 92 subjects in each group after matching data. The results indicated that levels of FT3, total triiodothyronine (TT3) and FT3/FT4 ratio in T2DM with NAFLD group were higher than those of T2DM without NAFLD group as well as total cholesterol (TC), triacylglycerol (TAG), low density lipoprotein cholesterol (LDL-C), glutamic-pyruvic transaminase (GPT), glutamic-oxaloacetic transaminase (GOT) and γ-glutamyl transferase (γ-GT) (all P<0.05). Multivariate linear regression analysis revealed that FT3 level and FT3/FT4 ratio were linearly positive with GPT and GOT levels, respectively (both P<0.05). TT3 was linearly positive with GPT, GOT and γ-GT levels. Logistic regression analysis showed that FT3 was independently associated with NAFLD inT2DM patients (P0.018). Furthermore, the ROC curve analysis verified the accuracy ofFT3/FT4 ratio for predicting NAFLD in T2DM patients (P0.005). Conclusion · In euthyroid T2DM patients, FT3 level and FT3/FT4 ratio positively correlate with NAFLD. Meanwhile, FT3/FT4 ratio might be useful for predicting NAFLD.
Key words: type 2 diabetes mellitus, non-alcoholic fatty liver disease, thyroid hormones
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