2023 年第 4 期 第 18 卷

甲状腺激素水平正常的血糖控制不佳2型糖尿病患者促甲状腺激素水平与代谢相关脂肪性肝病的相关性分析

The correlation between the level of thyroid-stimulating hormone and metabolic associated fatty liver disease in euthyroid type 2 diabetes mellitus patients with poor glucose control

作者：苗艳菊1李涛涛2赵一楠1陶红1

英文作者：Miao Yanju1 Li Taotao2 Zhao Yinan1 Tao Hong1

单位：1首都医科大学附属北京安贞医院内分泌代谢科，北京100029；2首都医科大学附属北京安贞医院风湿免疫科，北京100029

英文单位：1Department of Endocrinology and Metabolism Beijing Anzhen Hospital Capital Medical University Beijing 100029 China; 2Department of Rheumatology and Immunology Beijing Anzhen Hospital Capital Medical University Beijing 100029 China

关键词：2型糖尿病；代谢相关脂肪性肝病；促甲状腺激素；甲状腺功能

英文关键词：Type2diabetesmellitus;Metabolicassociatedfattyliverdisease;Thyroid-stimulatinghormone;Thyroidfunction

• 摘要：

• 目的 探讨甲状腺激素水平正常的血糖控制不佳2型糖尿病（T2DM）患者促甲状腺激素（TSH）水平与代谢相关脂肪性肝病（MAFLD）的相关性。方法 回顾性选取2015年1月至2019年12月于首都医科大学附属北京安贞医院内分泌代谢科住院的甲状腺激素水平正常的血糖控制不佳T2DM患者425例，根据腹部B超检查结果分为伴MAFLD组（210例）和不伴MAFLD组（215例）。比较各组一般资料及TSH、游离三碘甲状腺原氨酸、游离甲状腺素等代谢相关指标的差异。采用Logistic回归方法分析MAFLD发病的相关因素。结果 伴MAFLD组体重指数、腰围、舒张压、血尿酸、三酰甘油水平均显著高于不伴MAFLD组，饮酒史比例、高密度脂蛋白胆固醇（HDL-C）水平均显著低于不伴MAFLD组，差异均有统计学意义（均P<0.05）。伴MAFLD组的TSH水平显著高于不伴MAFLD组，差异有统计学意义［1.8(1.2，2.6)mIU/L比1.5(1.1，2.1)mIU/L］（Z=-3.25，P<0.01）。体重指数、TSH（比值比=1.292,95%置信区间：1.013～1.647）是甲状腺激素水平正常血糖控制不佳T2DM患者MAFLD发病的独立危险因素，HDL-C为独立保护因素（均P<0.05）。结论 在甲状腺激素水平正常的T2DM患者中，TSH水平与MAFLD的发病风险呈正相关，应重视对该类患者TSH水平的检测，及早防治MAFLD。

• Objective To investigate the correlation between the level of thyroid-stimulating hormone(TSH) and metabolic associated fatty liver disease(MAFLD) in euthyroid type 2 diabetes mellitus(T2DM) patients with poor glucose control. Methods From January 2015 to December 2019， totally 425 euthyroid T2DM patients with poor glucose control who were hospitalized in Department of Endocrinology and Metabolism, Beijing Anzhen Hospital, Capital Medical University were selected retrospectively. According to the results of abdominal ultrasonography, they were divided into the MAFLD group (210 cases) and non-MAFLD group(215 cases). The general data and the differences of related metabolic indexes such as TSH, free triiodothyronine(FT3), and free thyroxine(FT4) were compared between the two groups. Logistic regression method was used to analyze the related factors of MAFLD. Results The levels of body mass index, waist circumference, diastolic blood pressure, blood uric acid and triacylglycerol in the MAFLD group were significantly higher than those in the non-MAFLD group, and the proportion of drinking history and the level of high-density lipoprotein cholesterol(HDL-C) were significantly lower than those in the non-MAFLD group(all P<0.05). The TSH level in the MAFLD group was significantly higher than that in the non-MAFLD group［1.8(1.2,2.6)mIU/L vs 1.5(1.1,2.1)mIU/L］(Z=-3.25, P<0.01). Body mass index and TSH (odds ratio=1.292, 95% confidence interval: 1.013-1.647) were independent risk factors for MAFLD in euthyroid T2DM patients with poor glucose control, and HDL-C was an independent protective factor(all P<0.05). Conclusions  In euthyroid T2DM patients, the level of TSH is positively correlated with the risk of MAFLD. Attention should be paid to the detection of TSH level in these patients to prevent and treat MAFLD as early as possible.