Huang Bin, Yang Shengju, Ye Shandong
Department of Endocrinology, The First Affiliated Hospital of USTC, Division of Life Science and Medicine, University of Science and Technology of China, Hefei, Anhui 230001, China.
J Diabetes Res. 2020 Sep 5;2020:6538208. doi: 10.1155/2020/6538208. eCollection 2020.
Thyroid function and type 2 diabetes mellitus (T2DM) are both associated with increased risks of adverse clinical outcomes in nonalcoholic fatty liver disease (NAFLD). Our study is aimed at evaluating the association between thyroid function and NAFLD in T2DM patients with normal thyroid function (euthyroid) and analyzing the potential effects of metformin on the pathological process. Overall, 369 T2DM patients were enrolled between July 2017 and September 2018 and stratified into NAFLD and non-NAFLD groups. Data on age, gender, body mass index (BMI, kg/m), metformin use, and basal metabolic rate (BMR) were obtained from participants' records. All patients were tested for biochemical markers, indexes of glucose metabolism, lipid metabolism, bone metabolism, and thyroid function at baseline. Multivariate analyses detected increased odds of NAFLD among individuals with T2DM per unit increase in their BMI and free triiodothyronine (FT3) and thyroid stimulating hormone (TSH); the odds ratios (OR) were 1.25, 3.02, and 1.58, respectively (all < 0.05). Positive correlations were detected between alanine aminotransferase (ALT) and FT3 ( = 0.221, = 0.010), and negative correlations were noted between TSH and BMR ( = -0.618, < 0.001) and between BMR and FT3 ( = -0.452, < 0.001) in T2DM subjects with NAFLD. A significant difference in serum FT3 ( = 2.468, = 0.0167) and TSH ( = 2.658, = 0.010) levels was found between obese individuals with NAFLD who used and did not use metformin. The pathological mechanism of T2DM complicated by NAFLD in euthyroid patients may be associated with insulin resistance and a thyroid hormone resistance-like manifestation, i.e., relevant hypothyroidism. Metformin can potentially decrease the double-resistance situation, especially in obese individuals.
甲状腺功能与2型糖尿病（T2DM）均与非酒精性脂肪性肝病（NAFLD）不良临床结局风险增加相关。我们的研究旨在评估甲状腺功能正常（甲状腺功能正常）的T2DM患者中甲状腺功能与NAFLD之间的关联，并分析二甲双胍对病理过程的潜在影响。总体而言，2017年7月至2018年9月期间共纳入369例T2DM患者，并将其分为NAFLD组和非NAFLD组。从参与者记录中获取年龄、性别、体重指数（BMI，kg/m）、二甲双胍使用情况和基础代谢率（BMR）数据。所有患者在基线时均接受生化标志物、糖代谢指标、脂代谢指标、骨代谢指标和甲状腺功能检测。多变量分析发现，T2DM患者中，BMI、游离三碘甲状腺原氨酸（FT3）和促甲状腺激素（TSH）每单位增加，NAFLD的患病几率增加；比值比（OR）分别为1.25、3.02和1.58（均<0.05）。在患有NAFLD的T2DM受试者中，丙氨酸氨基转移酶（ALT）与FT3之间存在正相关（r = 0.221，P = 0.010），TSH与BMR之间以及BMR与FT3之间存在负相关（r分别为-0.618，P<0.001和r = -0.452，P<0.001）。在使用和未使用二甲双胍的肥胖NAFLD个体之间，血清FT3（t = 2.468，P = 0.0167）和TSH（t = 2.658，P = 0.010）水平存在显著差异。甲状腺功能正常的患者中T2DM合并NAFLD的病理机制可能与胰岛素抵抗和类似甲状腺激素抵抗的表现有关，即相关的甲状腺功能减退。二甲双胍可能会降低双重抵抗情况，尤其是在肥胖个体中。
