非酒精性脂肪性肝病合并2型糖尿病患者血浆促甲状腺激素水平变化及其临床意义*

doi:10.3969/j.issn.1672-5069.2019.01.018

摘要/Abstract

摘要： 目的研究非酒精性脂肪性肝病（NAFLD）合并2型糖尿病（T2DM）患者血清促甲状腺激素（TSH）水平的变化及其临床意义。方法纳入NAFLD合并T2DM患者43例和T2DM患者40例,比较两组年龄、性别、身高、体质指数（BMI）、血压和血生化指标及血清糖化血红蛋白（HbAlc）、空腹胰岛素（FINS）、游离三碘甲状腺原氨酸（FT3）、游离甲状腺素（FT4）、促甲状腺激素（TSH）等指标的差异,采用Logistic回归分析影响NAFLD患者发生T2DM的独立危险因素。结果 NAFLD合并T2DM患者体质指数（BMI）为（28.4±3.8） kg/m²,显著大于T2DM患者的（23.8±3.1） kg/m²,P<0.05）; NAFLD合并T2DM患者血清ALT、AST、GGT、TG、HOMA-IR和TSH水平显著高于T2DM患者（P<0.05）;不同血清TSH的NAFLD患者血清TC、TG、LDL-C和FT3水平存在显著性差异（P<0.05）;经Logistic回归分析显示,BMI（RR=1.720,95%CI为1.154~3.015）、HOMA-IR（RR=2.632,95%CI为1.010~3.654）、血清TSH（RR=2.577,95%CI为1.214~3.689）和TG水平（RR=1.538,95%CI为1.240~2.658）是影响NAFLD患者发生T2DM的独立危险因素。结论了解NAFLD患者发生T2DM的危险因素有助于早期预防和干预,检测血清TSH水平可能对筛查合并T2DM的NAFLD患者有一定的临床意义。

关键词: 非酒精性脂肪性肝病, 2型糖尿病, 促甲状腺激素, 筛查

Abstract: Objective To investigate the implication of plasma thyroid stimulating hormone （TSH） levels in patients with nonalcoholic fatty liver disease（NAFLD） and type 2 diabetes mellitus （T2DM）. Methods 43 patients with NAFLD and T2DM and 40 with T2DM were admitted to our hospital,and the patient's age,gender,height,body mass,body mass index（BMI）,insulin resistance index（HOMA IR）,systolic blood pressure,diastolic blood pressure,blood biochemical parameters and free three iodine thyroid original glycine（FT3）,free thyroxine（FT4） and TSH were compared between the two groups. Results The BMI in patients with NAFLD and T2DM was （28.4±3.8） kg/m²,significantly higher than（23.8±3.1） kg/m² in patients with T2DM （P<0.05）;serum ALT,AST,gamma glutamyl transpeptidase,triglyceride,HOMA-IR and TSH levels in patients with NAFLD and T2DM were much higher than those in patients with T2DM（P<0.05）;serum TC,TG,LDL-C and FT3 levels in three groups of NAFLD patients with different serum TSH levels were significantly different （P<0.05） as the patients with NAFLD were divided into low（n=14）,middle（n=16） and high（n=13） serum TSH levels;the Logistic analysis showed that BMI（RR=1.720,95%CI:1.154-3.015）,HOMA-IR（RR=2.632,95%CI:1.010-3.654）,serum TSH（RR=2.577,95%CI:1.214-3.689） and TG levels（RR=1.538,95%CI:1.240-2.658） were the independent risk factors for the occurrence of T2DM in patients with NAFLD. Conclusion The clinicians should take the risk factors of T2DM occurrence in patients with NAFLD into consideration in clinical practice for early prevention and intervention,and the detection of serum TSH level might be helpful in dealing with patients in this settings.

Key words: Non-alcoholic fatty liver disease, Type 2 diabetes, Thyrotropin, Screening

宋娜, 刘晓燕, 刘畅, 山秀杰, 苏东峰, 李丽慧. 非酒精性脂肪性肝病合并2型糖尿病患者血浆促甲状腺激素水平变化及其临床意义^*[J]. 实用肝脏病杂志, 2019, 22(1): 65-68.

Song Na, Liu Xiaoyan, Liu Chang, et al.. Changes of plasma thyrotropin levels in patients with nonalcoholic fatty liver disease and type 2 diabetes[J]. JOURNAL OF PRACTICAL HEPATOLOGY, 2019, 22(1): 65-68.

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非酒精性脂肪性肝病合并2型糖尿病患者血浆促甲状腺激素水平变化及其临床意义^*

Changes of plasma thyrotropin levels in patients with nonalcoholic fatty liver disease and type 2 diabetes

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