1 安徽医科大学第三附属医院/合肥市第一人民医院内分泌科，合肥 230031
目的：探讨甲状腺功能正常的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)值与非酒精性脂肪性肝病(non-alcoholic fatty liver disease，NAFLD)的相关性。方法：收集2010年1月至2016年12月于安徽医科大学第三附属医院内分泌科住院的1 018例T2DM患者的临床资料。根据是否合并NAFLD分为T2DM组和NAFLD组，另根据FT3水平分为<3.70，3.70~4.19及>4.19 pmol/L组，比较各组一般资料及生化指标，分析FT3，FT3/FT4值及NAFLD的患病率，采用Spearman相关分析NAFLD与各指标的相关性，采用ROC曲线分析FT3/FT4值预测NAFLD的患病风险。结果：与T2DM组比较，NAFLD组年龄更小，病程更短，BMI，收缩压，ALT，AST，GGT，SUA，TG，TC，FT3，FT3/FT4，FCP更高，HDL-C更低(P<0.05)；随着FT3水平的提高，ALT，GGT，TG，TC，FCP也明显上升，sCr下降(P<0.05)；按照FT3水平和FT3/FT4值的三分位数进行分组后，NAFLD患病率随FT3水平，FT3/FT4值升高呈显著上升趋势，根据Spearman相关分析显示NAFLD与BMI，ALT，AST，GGT，SUA，TC，TG，HDL-C，FT3/FT4，FT3，FCP呈正相关(P<0.01)，与年龄和病程呈负相关(P<0.05)；进一步的ROC曲线分析发现，FT3/FT4值可作为预测NAFLD患病风险的血清学参考指标。结论：甲状腺功能正常T2DM患者的血清FT3水平及FT3/FT4值与NAFLD患病风险呈独立正相关，FT3/FT4比值可有效预测NAFLD患病风险。
Correlation between the levels of serum thyroid hormones and non-alcoholic fatty liver disease in type 2 diabetic patients with normal thyroid function
CorrespondingAuthor: LIU Shangquan
This work was supported by the National Natural Science Foundation of China (30840106).
Objective: To investigate the correlation between serum thyroid hormone level and free triiodothyronine( FT3) /free thyroxine (FT4) ratio and non-alcoholic fatty liver disease (NAFLD) in type-2 diabetes mellitus (T2DM) patients with normal thyroid function. Methods: Clinical data of 1 018 patients with T2DM admitted to the Department of Endocrinology, The Third Affiliated Hospital of Anhui Medical University from January 2010 to December 2016 were collected. The patients were divided into a T2DM group and a NAFLD group with or without NAFLD, and into the FT3 <3.70, 3.70–4.19 and >4.19 pmol/L groups according to the FT3 level. General information and biochemical indicators were compared in each group, and FT3, FT3/FT4 ratio and the prevalence of NAFLD were analyzed. Spearman correlation analysis was used to analyze the correlation between NAFLD and each indicator, and the ROC curve was used to analyze the FT3/FT4 ratio to predict the risk of NAFLD. Results: Compared with the T2DM group, the patients in the NAFLD group were younger, had a shorter course of disease, with higher BMI, systolic blood pressure, ALT, AST, GGT, SUA, TG, TC, FT3, FT3/FT4, and FCP and lower HDL-C (P<0.05); with the improvement of FT3 level, ALT, GGT, TG, TC, FCP also increased significantly, while SCR decreased (P<0.05). After grouping according to FT3 level and FT3/FT4 value, the prevalence of NAFLD increased significantly with the increase of FT3 level and FT3/FT4 ratio. Spearman correlation analysis showed that NAFLD was positively correlated with BMI, ALT, AST, GGT, SUA, TC, TG, HDL-C, FT3/FT4, FT3 and FCP (P<0.01), and negatively correlated with age and disease course (P<0.05). Further ROC curve analysis revealed that FT3/FT4 ratio could be used as a serological indicator to predict the risk of NAFLD. Conclusion: The serum FT3 level and FT3/FT4 ratio in T2DM patients with normal thyroid function are independently and positively correlated with the risk of NAFLD, and the FT3/FT4 ratio may effectively predict the risk of NAFLD.
type 2 diabetes mellitus; non-alcoholic fatty liver disease; thyroid hormones