Department of Gastroenterology, Beijing Tiantan Hospital, Capital Medical University, Beijing, China.
Department of Health Care, Qingdao Municipal Hospital (East), Qingdao, China.
Ann Palliat Med. 2022 Feb;11(2):655-662. doi: 10.21037/apm-21-3890.
Non-alcoholic fatty liver disease (NAFLD) has become a major public health problem concern in recent decades. The specific mechanism of NAFLD is still not clear. Previous studies had shown the correlation between NAFLD and thyroid dysfunction. The correlation between thyroid hormones within the euthyroid range and NAFLD has not yet been clarified. This study sought to investigate the association between NAFLD and thyroid hormones in euthyroid patients.
A retrospective cross-sectional study was conducted at Beijing Tiantan Hospital from January 1, 2019, to October 1, 2021. Eighty-one NAFLD patients with normal thyroid function and 34 healthy individuals were enrolled. Participants' demographic information, biochemical parameters, and thyroid hormone levels were collected. The severity of NAFLD was assessed by abdominal computed tomography (CT). The association between NAFLD and thyroid hormones was analyzed.
Patients in the NAFLD group were older and more likely to be female than those in the healthy control group (P<0.05). Compared to the healthy control group, the serum levels of fasting plasma glucose (FPG), alanine transaminase (ALT), plasma aspartate transaminase (AST), triglyceride, gamma-glutamyl transferase (γ-GT), and uric acid (UA) were higher, but the levels of high-density lipoprotein cholesterol (HDL-C), and free thyroxine (FT4) were lower in the NAFLD group (P<0.05). NAFLD is more severe in females than males (P<0.05). ALT, AST, low-density lipoprotein cholesterol (LDL-C), γ-GT, tetraiodothyronine, and free triiodothyronine (FT3) levels increased significantly as the severity of NAFLD increased (P<0.05). The results of the Spearman correlation analysis indicated that the severity of NAFLD was positively correlated with ALT (r=0.376, P=0.001), AST (r=0.275, P=0.015), and LDL (r=0.313, P=0.007). The multiple logistic regression analysis showed that age [odds ratio (OR) =1.071; 95% confidence interval (CI): 1.010-1.136, P=0.021], ALT (OR =1.091; 95% CI: 1.034-1.150, P=0.001), HDL-C (OR =0.085; 95% CI: 0.010-0.690, P=0.021), and FT4 (OR =0.738; 95% CI: 0.545-1.001, P=0.046) were independently related to the risk of NAFLD in patients with normal thyroid function.
FT4 within the normal range was lower in the NAFLD group compared to the healthy control group. The serum level of FT4 is an independent risk factor of NAFLD in euthyroid people.
非酒精性脂肪性肝病（NAFLD）在近几十年来已成为一个主要的公共卫生问题。NAFLD 的具体发病机制仍不清楚。先前的研究表明 NAFLD 与甲状腺功能障碍之间存在相关性。甲状腺功能正常人群中甲状腺激素与 NAFLD 之间的关系尚未阐明。本研究旨在探讨甲状腺功能正常人群中 NAFLD 与甲状腺激素之间的关系。
本研究为 2019 年 1 月 1 日至 2021 年 10 月 1 日期间在北京天坛医院进行的回顾性横断面研究。纳入 81 例甲状腺功能正常的 NAFLD 患者和 34 例健康对照者。收集参与者的人口统计学信息、生化参数和甲状腺激素水平。采用腹部 CT 评估 NAFLD 的严重程度。分析 NAFLD 与甲状腺激素之间的关系。
与健康对照组相比，NAFLD 组患者年龄较大，女性比例较高（P<0.05）。与健康对照组相比，NAFLD 组患者的空腹血糖（FPG）、丙氨酸转氨酶（ALT）、天门冬氨酸转氨酶（AST）、甘油三酯、γ-谷氨酰转移酶（γ-GT）和尿酸（UA）水平较高，而高密度脂蛋白胆固醇（HDL-C）和游离甲状腺素（FT4）水平较低（P<0.05）。女性 NAFLD 比男性更严重（P<0.05）。随着 NAFLD 严重程度的增加，ALT、AST、低密度脂蛋白胆固醇（LDL-C）、γ-GT、甲状腺素（T4）和游离三碘甲状腺原氨酸（FT3）水平显著升高（P<0.05）。Spearman 相关分析结果表明，NAFLD 的严重程度与 ALT（r=0.376，P=0.001）、AST（r=0.275，P=0.015）和 LDL（r=0.313，P=0.007）呈正相关。多因素 logistic 回归分析显示，年龄[比值比（OR）=1.071；95%置信区间（CI）：1.010-1.136，P=0.021]、ALT（OR=1.091；95%CI：1.034-1.150，P=0.001）、HDL-C（OR=0.085；95%CI：0.010-0.690，P=0.021）和 FT4（OR=0.738；95%CI：0.545-1.001，P=0.046）是甲状腺功能正常人群发生 NAFLD 的独立危险因素。
与健康对照组相比，甲状腺功能正常的 NAFLD 患者的 FT4 水平较低。FT4 水平是甲状腺功能正常人群发生 NAFLD 的独立危险因素。
