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揭示甲状腺功能减退在非酒精性脂肪性肝病发病机制中的作用:相关性、矛盾之处及当前立场。

Unraveling the Role of Hypothyroidism in Non-alcoholic Fatty Liver Disease Pathogenesis: Correlations, Conflicts, and the Current Stand.

作者信息

Gor Rajvi, Siddiqui Nabeel A, Wijeratne Fernando Ransirini, Sreekantan Nair Archana, Illango Janan, Malik Mushrin, Hamid Pousette

机构信息

Research, California Institute of Behavioral Neurosciences & Psychology, Fairfield, USA.

Neurology, California Institute of Behavioral Neurosciences & Psychology, Fairfield, USA.

出版信息

Cureus. 2021 May 5;13(5):e14858. doi: 10.7759/cureus.14858.

Abstract

Non-alcoholic fatty liver disease (NAFLD) has become one of the most common causes of chronic liver diseases globally. Because thyroid hormones play a crucial role in lipid metabolism, thyroid dysfunction has been implicated in NAFLD pathogenesis in the past decade, with hypothyroidism-induced NAFLD being regarded as a distinct disease entity. However, there has been no common consensus yet, and several studies have found contradictory results. Hence, we conducted this systematic review to represent the current view on the role of hypothyroidism (HT) and individual thyroid function parameters such as thyroid-stimulating hormone (TSH), thyroxine (T4), triiodothyronine (T3), thyroid peroxidase antibody (TPOAb), and thyroglobulin antibody (TGAb) in NAFLD pathogenesis. We searched PubMed, PubMed Central, and Semantic Scholar databases from inception until January 2021 to identify relevant observational (case-control, cross-sectional, and longitudinal) studies. A total of 699 articles were recognized through our database search. After applying the eligibility criteria and performing quality assessment, 10 studies involving 42,227 participants were included in the final systematic review. Each of these studies assessed different thyroid function parameters, and NAFLD was found to be associated with HT in two studies, elevated TSH in three studies, suppressed T4 in three studies, elevated T3 in one study, and elevated TPOAb in one study. There was also a wide heterogeneity in HT definition, study population characteristics, and study design among these studies, making a direct comparison difficult. Because the recognition of HT-induced NAFLD has possible diagnostic, therapeutic, and prognostic implications, we recommend that comprehensive, long-term prospective studies be carried out to determine if HT or thyroid function parameters are causally associated with NAFLD.

摘要

非酒精性脂肪性肝病(NAFLD)已成为全球慢性肝病最常见的病因之一。由于甲状腺激素在脂质代谢中起关键作用,过去十年甲状腺功能障碍被认为与NAFLD发病机制有关,甲状腺功能减退症所致NAFLD被视为一种独特的疾病实体。然而,目前尚未达成共识,多项研究结果相互矛盾。因此,我们进行了这项系统评价,以阐述目前关于甲状腺功能减退症(HT)以及促甲状腺激素(TSH)、甲状腺素(T4)、三碘甲状腺原氨酸(T3)、甲状腺过氧化物酶抗体(TPOAb)和甲状腺球蛋白抗体(TGAb)等个体甲状腺功能参数在NAFLD发病机制中作用的观点。我们检索了PubMed、PubMed Central和Semantic Scholar数据库,检索时间从数据库创建至2021年1月,以识别相关的观察性(病例对照、横断面和纵向)研究。通过数据库检索共识别出699篇文章。在应用纳入标准并进行质量评估后,最终的系统评价纳入了10项涉及42227名参与者的研究。这些研究每项评估的甲状腺功能参数不同,其中两项研究发现NAFLD与HT有关,三项研究发现与TSH升高有关,三项研究发现与T4降低有关,一项研究发现与T3升高有关,一项研究发现与TPOAb升高有关。这些研究在HT定义、研究人群特征和研究设计方面也存在很大异质性,难以进行直接比较。鉴于认识到HT所致NAFLD可能具有诊断、治疗和预后意义,我们建议开展全面、长期的前瞻性研究,以确定HT或甲状腺功能参数是否与NAFLD存在因果关系。

https://cdn.ncbi.nlm.nih.gov/pmc/blobs/c7c9/8174393/e8c9a48c6e56/cureus-0013-00000014858-i01.jpg

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