非酒精性脂肪性肝病患者在碳水化合物代谢紊乱背景下的亚临床甲状腺功能减退。

Subclinical hypothyroidism in patients with non-alcoholic fatty liver disease at the background of carbohydrate metabolism disorders.

作者信息

Feisa Snizhana V, Chopei Ivan V

机构信息

Therapy and Family Medicine Department, Uzhhorod National University, Uzhhorod, Ukraine.

出版信息

Wiad Lek. 2018;71(2 pt 1):261-264.

PMID:29729151

Abstract

OBJECTIVE

Introduction: The prevalence of non-alcoholic fatty liver disease (NAFLD) is 25-30% in the general population and more than 75% among patients with carbohydrate metabolism disorders. One in six patients with NAFLD has concomitant subclinical hypothyroidism. The aim is to compare lipid and carbohydrate metabolism states in patients with NAFLD depending on the functional state of the thyroid gland.

PATIENTS AND METHODS

Materials and methods:215 patients with NAFLD and type 2 diabetes mellitus (T2-DM) or pre-diabetes (PD) were involved in study and devided into 6 groups according to the functional state of the thyroid gland.

RESULTS

Results: In cases of adding subclinical hypothyroidism systolic and diastolic blood pressure are rising. In patients with overt hypothyroidism average HOMA-IR index is 29,98±1,05, which exceeds the corresponding figure in patients with concomitant subclinical hypothyroidism. In patients whose hypothyroidism has been compensated by levothyroxine, HOMA-IR index was reduced to 18,56±1,58, indicating a tendency to restore the sensitivity of peripheral tissues to insulin, on the assumption under the medicatedcorrection of thyroid functional status. Levels of common cholesterol and triglycerides were higher in cases of NAFLD with subclinical or overt hypothyroidism than in patients with NAFLD and normal thyroid function. Replacement therapy by levothyroxine leads to improving of lipid changes in patients with NAFLD and concomitant overt hypothyroidism: the levels of common cholesterol and triglycerides were reducing from 6,04±1,18 mmol/l and 3,96±1,34 mmol/l to 5,97±1,1 mmol/l and 3,45±1,13 mmol/l in accordance.

CONCLUSION

Conclusions: Concomitant subclinical hypothyroidism in patients with NAFLD at the background of carbohydrate metabolism disorders leads to atherogenic dyslipidemia, increasing of blood atherogenicity. The index of lipid accumulated product (LAP) and the resistance of peripheral tissues to insulin also increases.

摘要

目的

引言：非酒精性脂肪性肝病（NAFLD）在普通人群中的患病率为25%-30%，在碳水化合物代谢紊乱患者中超过75%。每六名NAFLD患者中就有一名伴有亚临床甲状腺功能减退。目的是根据甲状腺的功能状态比较NAFLD患者的脂质和碳水化合物代谢状态。

患者与方法

材料与方法：215例患有NAFLD和2型糖尿病（T2-DM）或糖尿病前期（PD）的患者参与研究，并根据甲状腺的功能状态分为6组。

结果

结果：合并亚临床甲状腺功能减退时，收缩压和舒张压升高。显性甲状腺功能减退患者的平均HOMA-IR指数为29.98±1.05，超过合并亚临床甲状腺功能减退患者的相应数值。在甲状腺功能减退已通过左甲状腺素得到代偿的患者中，HOMA-IR指数降至18.56±1.58，表明在药物纠正甲状腺功能状态的情况下，外周组织对胰岛素的敏感性有恢复趋势。合并亚临床或显性甲状腺功能减退的NAFLD患者的总胆固醇和甘油三酯水平高于甲状腺功能正常的NAFLD患者。左甲状腺素替代治疗可改善合并显性甲状腺功能减退的NAFLD患者的脂质变化：总胆固醇和甘油三酯水平相应地从6.04±1.18 mmol/l和3.96±1.34 mmol/l降至5.97±1.1 mmol/l和3.45±1.13 mmol/l。