Wang Chenyi, Niu Qianglong, Lv Haihong, Li Qian, Ma Yuping, Tan Jiaojiao, Liu Chunhua
Department of Endocrinology, The First Hospital of Lanzhou University, Lanzhou, Gansu 730000, People's Republic of China.
Department of Endocrinology, The First Clinical Medical College of Lanzhou University, Lanzhou, Gansu, 730000, People's Republic of China.
Diabetes Metab Syndr Obes. 2020 Nov 16;13:4369-4378. doi: 10.2147/DMSO.S280231. eCollection 2020.
The aim of this study was to assess the prevalence of thyroid autoimmunity in T2DM with NAFLD, furthermore explore the relationship between elevated TPOAb titer and the severity of NAFLD.
A total of 400 patients with T2DM were divided into two groups according to NAFLD. Thyroid function and other metabolic indicators were measured.
There were more TPOAb-positive patients in both groups, and the prevalence of TPOAb positive was significantly different in two groups (17% vs 6.9%, p< 0.01). FT4 was significantly lower in patients with T2DM with NAFLD (median FT4 0.89 vs 1.08, p < 0.001), while TSH was increased (median TSH 2.85 vs 2.28, p < 0.05). In patients with T2DM with NAFLD, the proportion of women in the thyroid autoimmune-positive group was significantly higher than the negative (71.1% vs 46%, p < 0.01). Similarly, thyroid autoimmune-positive T2DM and NAFLD patients had lower FT4 levels (median FT4 0.59 vs 0.92, p < 0.001), higher TSH levels (median TSH 3.65 vs 2.67, p < 0.001), and much higher TPOAb/TGAb (median TPOAb/TGAb 6.8 vs 1.46, p < 0.001). The increase of TPOAb was significantly correlated with the severity of fatty liver. HbA1c, TC, TG, TSH, TPOAb/TGAb and severity of fatty liver were risk factors of thyroid autoimmunity.
Autoimmune thyroid disease is more common in patients with T2DM complicated with NAFLD. Elevated TPOAb titer is closely related to fatty liver, suggesting that elevated TPOAb titer is a predictor of autoimmune development in T2DM with NAFLD.
本研究旨在评估2型糖尿病合并非酒精性脂肪性肝病（NAFLD）患者中甲状腺自身免疫的患病率，并进一步探讨甲状腺过氧化物酶抗体（TPOAb）滴度升高与NAFLD严重程度之间的关系。
将400例2型糖尿病患者根据是否患有NAFLD分为两组。检测甲状腺功能及其他代谢指标。
两组中TPOAb阳性患者均较多，且两组TPOAb阳性患病率有显著差异（17%对6.9%，p<0.01）。2型糖尿病合并NAFLD患者的游离甲状腺素（FT4）显著降低（中位数FT4 0.89对1.08，p<0.001），而促甲状腺激素（TSH）升高（中位数TSH 2.85对2.28，p<0.05）。在2型糖尿病合并NAFLD患者中，甲状腺自身免疫阳性组女性比例显著高于阴性组（71.1%对46%，p<0.01）。同样，甲状腺自身免疫阳性的2型糖尿病和NAFLD患者FT4水平较低（中位数FT4 0.59对0.92，p<0.001），TSH水平较高（中位数TSH 3.65对2.67，p<0.001），且TPOAb/甲状腺球蛋白抗体（TGAb）高得多（中位数TPOAb/TGAb 6.8对1.46，p<0.001）。TPOAb升高与脂肪肝严重程度显著相关。糖化血红蛋白（HbA1c）、总胆固醇（TC）、甘油三酯（TG）、TSH、TPOAb/TGAb及脂肪肝严重程度是甲状腺自身免疫的危险因素。
自身免疫性甲状腺疾病在2型糖尿病合并NAFLD患者中更为常见。TPOAb滴度升高与脂肪肝密切相关，提示TPOAb滴度升高是2型糖尿病合并NAFLD患者自身免疫发展的一个预测指标。
