Relationship between Thyroid Hormone Levels and Non-alcoholic Fatty Liver Disease in Euthyroid Population

doi:10.12114/j.issn.1007-9572.2019.00.494

Abstract

Abstract: Background　The incidence of non-alcoholic fatty liver disease（NAFLD） is rising year by year，and is increasingly occurring in younger people.Moreover，its occurrence is related to the components of metabolic syndrome，while hypothyroidism is closely related to the occurrence of metabolic syndrome.Currently，the relationship between thyroid hormone levels and NAFLD in people with normal thyroid function in studies has not been determined.Objective　To investigate the relationship between thyroid hormone levels and NAFLD in people with normal thyroid function，so as to provide a basis for the prevention and treatment of NAFLD.Methods　From the hospital information system database of the First Affiliated Hospital of China Medical University，15 660 physical examinees with normal thyroid function were enrolled during January 2013 to October 2018.By color Doppler ultrasound examination of the liver，7 095 were found with NAFLD（NAFLD group），and 8 565 without（non-NAFLD group）．The levels of thyroid-stimulating hormone（TSH），free triiodothyroine（FT3） and free thyroxine（FT4） in the two groups were compared.Logistic regression analysis was conducted to explore the changes in prevalence of NAFLD by thyroid hormone level.Stepwise multiple Logistic regression was used to analyze the effect of thyroid hormone level on the prevalence of NAFLD.Results　NAFLD group showed higher mean serum levels of TSH and FT3，and lower mean serum FT4 level compared with non-NAFLD group（P<0.05）．The prevalence of NAFLD increased with the elevation of serum TSH and FT3 levels but reduced with the growth of FT4 level（Ptrend<0.05）．Stepwise multiple regression analysis showed that after excluding the multicollinearity effect of thyroid hormone level，and adjusting for sex，age and other metabolism-related indicators，serum TSH〔OR=1.065，95%CI（1.019，1.113）〕，FT3〔OR=1.175，95%CI（1.078，1.282）〕，and FT4〔OR=0.934，95%CI（0.908，0.961）〕 levels were the influencing factors of NAFLD（P<0.05）．Conclusion　In people with normal thyroid function，higher serum TSH and FT3 levels and lower serum FT4 level are associated with higher risk of NAFLD.To effectively prevent and delay the occurrence and development of NAFLD in this group，health managers should focus on monitoring the changes of TSH，FT3 and FT4 levels.

Key words: Fatty liver, alcoholic；Thyroid hormones；Metabolic syndrome X；Root cause analysis

摘要： 背景　非酒精性脂肪肝（NAFLD）的发病率呈年轻化和逐年增加趋势，其发生与代谢综合征各组分有关，而甲状腺功能减退与代谢综合征的发生密切相关。目前，关于甲状腺功能正常人群中甲状腺激素水平与NAFLD关系的研究尚存在差异。目的　探讨甲状腺功能正常人群中甲状腺激素水平与NAFLD的关系，为NAFLD的防治提供依据。方法　在中国医科大学附属第一医院的医院信息系统（HIS）中选取2013年1月—2018年10月进行健康体检的甲状腺功能正常者15 660例，根据彩超检查结果，分为NAFLD组7 095例和非NAFLD组8 565例。比较两组促甲状腺素（TSH）、游离三碘甲状腺氨酸（FT3）、游离甲状腺素（FT4）水平，采用Logistic回归分析NAFLD患病率随甲状腺激素水平的变化，采用多元逐步Logistic回归分析甲状腺激素水平对NAFLD患病的影响。结果　NAFLD组的血清TSH和FT3水平高于非NAFLD组，血清FT4水平低于非NAFLD组（P<0.05）。NAFLD患病率随血清TSH和FT3水平升高而上升，随血清FT4水平升高而下降（P趋势<0.05）。多元逐步Logistic回归分析结果显示，排除了甲状腺激素水平的共线性影响，调整了性别、年龄及其他代谢相关指标的影响后，血清TSH、FT3、FT4水平是NAFLD患病与否的影响因素〔OR（95%CI）分别为1.065（1.019，1.113）、1.175（1.078，1.282）、0.934（0.908，0.961），P<0.05〕。结论　在甲状腺功能正常的人群中，血清TSH、FT3水平越高，血清FT4水平越低，NAFLD的患病风险越高。健康管理师应重点监测这部分人群的TSH、FT3及FT4水平变化，从而有效预防和延缓NAFLD的发生发展。

关键词: 脂肪肝, 酒精性；甲状腺激素类；代谢综合征X；影响因素分析

LIU Yiting,WANG Wei. Relationship between Thyroid Hormone Levels and Non-alcoholic Fatty Liver Disease in Euthyroid Population　[J]. Chinese General Practice, 2019, 22(25): 3088-3093. DOI: 10.12114/j.issn.1007-9572.2019.00.494.
刘奕婷,王巍. 正常甲状腺功能人群甲状腺激素水平与非酒精性脂肪肝的关系研究[J]. 中国全科医学, 2019, 22(25): 3088-3093. DOI: 10.12114/j.issn.1007-9572.2019.00.494.

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