Meta-Analysis Interest Group & Liver Cirrhosis Group, Department of Gastroenterology, General Hospital of Shenyang Military Area, Shenyang, China; Postgraduate College, Dalian Medical University, Dalian, China.
Meta-Analysis Interest Group & Liver Cirrhosis Group, Department of Gastroenterology, General Hospital of Shenyang Military Area, Shenyang, China.
Dig Liver Dis. 2018 Nov;50(11):1153-1162. doi: 10.1016/j.dld.2018.08.012. Epub 2018 Aug 23.
Nonalcoholic fatty liver disease (NAFLD) is one of the most common chronic liver diseases. The relationship of NAFLD with thyroid function parameters and hypothyroidism remains controversial.
To clarify the effect of thyroid function parameters and hypothyroidism on the development of NAFLD and progression to nonalcoholic steatohepatitis (NASH).
PubMed, EMBASE, and Cochrane library databases were searched. Study quality was assessed. Weighted mean difference (WMD) and odds ratio (OR) with 95% confidence interval (CI) were calculated.
Twenty six studies involving 61,548 participants were eligible, most of which were of high quality. NAFLD/NASH patients had significantly higher TSH levels than controls in adults (NAFLD versus health: WMD = 0.105, 95%CI = 0.012-0.197; NAFLD versus euthyroidism: WMD = 0.100, 95%CI = 0.005-0.194; NASH versus NAFLD: WMD = 0.540, 95%CI = 0.136-0.944) and children/adolescents (NAFLD versus lean controls: WMD = 1.039, 95%CI = 0.104-1.973; NAFLD versus overweight/obese controls: WMD = 0.485, 95%CI = 0.267-.703). Unclassified hypothyroidism was positively associated with the risk of NAFLD/NASH in adults (NAFLD versus health: OR = 1.605, 95%CI = 1.180-2.183; NASH versus NAFLD: OR = 2.317, 95%CI = 1.425-3.768) and children/adolescents (NAFLD versus overweight/obese controls: OR = 2.015, 95%CI = 1.246-3.258). However, the statistical results were inconsistent among the subgroup meta-analyses of subclinical and overt hypothyroidism. Association of NAFLD with FT3 and FT4 levels was heterogeneous among population.
TSH level may be an important risk factor for the development and progression of NAFLD, independent of thyroid hormones.
非酒精性脂肪性肝病（NAFLD）是最常见的慢性肝病之一。NAFLD 与甲状腺功能参数和甲状腺功能减退症之间的关系仍存在争议。
阐明甲状腺功能参数和甲状腺功能减退症对 NAFLD 的发展和进展为非酒精性脂肪性肝炎（NASH）的影响。
检索了 PubMed、EMBASE 和 Cochrane 图书馆数据库。评估了研究质量。计算了加权均数差（WMD）和比值比（OR）及其 95%置信区间（CI）。
共有 26 项研究纳入了 61548 名参与者，其中大多数研究质量较高。成人中，NAFLD/NASH 患者的 TSH 水平明显高于对照组（NAFLD 与健康人群相比：WMD=0.105，95%CI=0.012-0.197；NAFLD 与甲状腺功能正常人群相比：WMD=0.100，95%CI=0.005-0.194；NASH 与 NAFLD 相比：WMD=0.540，95%CI=0.136-0.944）和儿童/青少年（NAFLD 与瘦对照组相比：WMD=1.039，95%CI=0.104-1.973；NAFLD 与超重/肥胖对照组相比：WMD=0.485，95%CI=0.267-0.703）。未分类的甲状腺功能减退症与成人中 NAFLD/NASH 的风险呈正相关（NAFLD 与健康人群相比：OR=1.605，95%CI=1.180-2.183；NASH 与 NAFLD 相比：OR=2.317，95%CI=1.425-3.768）和儿童/青少年（NAFLD 与超重/肥胖对照组相比：OR=2.015，95%CI=1.246-3.258）。然而，亚临床和显性甲状腺功能减退症的亚组荟萃分析结果不一致。NAFLD 与 FT3 和 FT4 水平的相关性在人群中存在异质性。
TSH 水平可能是 NAFLD 发生和发展的重要危险因素，独立于甲状腺激素。
