甲状腺功能减退对非酒精性脂肪性肝病发生发展的影响：一项为期4年的回顾性队列研究。
Impact of hypothyroidism on the development of non-alcoholic fatty liver disease: A 4-year retrospective cohort study.
作者信息
Lee Kil Woo, Bang Ki Bae, Rhee Eun Jung, Kwon Heon Ju, Lee Mi Yeon, Cho Yong Kyun
机构信息
Department of Gastroenterology, Kangbuk Samsung Hospital, Sungkyunkwan University School of Medicine, Seoul, Korea.
Department of Gastroenterology, Dankook University Hospital, Dankook University College of Medicine, Cheonan, Korea.
出版信息
Clin Mol Hepatol. 2015 Dec;21(4):372-8. doi: 10.3350/cmh.2015.21.4.372. Epub 2015 Dec 24.
BACKGROUND/AIMS: Hypothyroidism is reported to contribute to the development of nonalcoholic fatty liver disease (NAFLD). We compared the risk of the development of NAFLD among three groups with different thyroid hormonal statuses (control, subclinical hypothyroidism, and overt hypothyroidism) in a 4-year retrospective cohort of Korean subjects.
METHODS
Apparently healthy Korean subjects without NAFLD and aged 20-65 years were recruited (n=18,544) at health checkups performed in 2008. Annual health checkups were applied to the cohort for 4 consecutive years until December 2012. Based on their initial serum-free thyroxine (fT4) and thyroid-stimulating hormone (TSH) levels, they were classified into control, subclinical hypothyroidism (TSH >4.2 mIU/L, normal fT4), and overt hypothyroidism (TSH >4.2 mIU/L, fT4 <0.97 ng/dL) groups. NAFLD was diagnosed on the basis of ultrasonography findings.
RESULTS
NAFLD developed in 2,348 of the 18,544 subjects, representing an overall incidence of 12.7%: 12.8%, 11.0%, 12.7% in the control, subclinical hypothyroidism, and overt hypothyroidism groups, respectively. The incidence of NAFLD did not differ significantly with the baseline thyroid hormonal status, even after multivariate adjustment (subclinical hypothyroidism group: hazard ratio [HR]=0.965, 95% confidence interval [CI]=0.814-1.143, P=0.67; overt hypothyroidism group: HR=1.255, 95% CI=0.830-1.899, P=0.28).
CONCLUSIONS
Our results suggest that the subclinical and overt types of hypothyroidism are not related to an increased incidence of NAFLD.
背景/目的：据报道，甲状腺功能减退症会促使非酒精性脂肪性肝病（NAFLD）的发生。我们在一个针对韩国受试者的4年回顾性队列研究中，比较了三组甲状腺激素状态不同（对照组、亚临床甲状腺功能减退症组和显性甲状腺功能减退症组）人群发生NAFLD的风险。
方法
在2008年进行的健康检查中招募了年龄在20 - 65岁、无NAFLD的明显健康的韩国受试者（n = 18544）。该队列连续4年接受年度健康检查，直至2012年12月。根据他们最初的血清游离甲状腺素（fT4）和促甲状腺激素（TSH）水平，将他们分为对照组、亚临床甲状腺功能减退症组（TSH>4.2 mIU/L，fT4正常）和显性甲状腺功能减退症组（TSH>4.2 mIU/L，fT4<0.97 ng/dL）。NAFLD根据超声检查结果进行诊断。
结果
18544名受试者中有2348人发生了NAFLD，总体发病率为12.7%：对照组、亚临床甲状腺功能减退症组和显性甲状腺功能减退症组的发病率分别为12.8%、11.0%和12.7%。即使经过多变量调整，NAFLD的发病率与基线甲状腺激素状态也没有显著差异（亚临床甲状腺功能减退症组：风险比[HR]=0.965，95%置信区间[CI]=0.814 - 1.143，P = 0.67；显性甲状腺功能减退症组：HR = 1.255，95% CI = 0.830 - 1.899，P = 0.28）。
结论
我们的结果表明，亚临床和显性甲状腺功能减退症类型与NAFLD发病率增加无关。
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