Institute for Clinical Diabetology, German Diabetes Center, Leibniz Institute for Diabetes Research at Heinrich Heine University, Düsseldorf, Germany.
German Center for Diabetes Research (DZD e.V.), München-Neuherberg, Germany.
Liver Int. 2024 Jan;44(1):27-38. doi: 10.1111/liv.15723. Epub 2023 Sep 12.
Non-alcoholic fatty liver disease (NAFLD) has been linked to type 2 diabetes (T2D), but also to hypothyroidism. Nevertheless, the relationship between thyroid function and NAFLD in diabetes is less clear. This study investigated associations between free thyroxine (fT4) or thyroid-stimulating hormone (TSH) and NAFLD in recent-onset diabetes.
Participants with recent-onset type 1 diabetes (T1D, n = 358), T2D (n = 596) or without diabetes (CON, n = 175) of the German Diabetes Study (GDS), a prospective longitudinal cohort study, underwent Botnia clamp tests and assessment of fT4, TSH, fatty liver index (FLI) and in a representative subcohort H-magnetic resonance spectroscopy.
First, fT4 levels were similar between T1D and T2D (p = .55), but higher than in CON (T1D: p < .01; T2D: p < .001), while TSH concentrations were not different between all groups. Next, fT4 correlated negatively with FLI and positively with insulin sensitivity only in T2D (ß = -.110, p < .01; ß = .126, p < .05), specifically in males (ß = -.117, p < .05; ß = .162; p < .01) upon adjustments for age, sex and BMI. However, correlations between fT4 and FLI lost statistical significance after adjustment for insulin sensitivity (T2D: ß = -.021, p = 0.67; males with T2D: ß = -.033; p = .56). TSH was associated positively with FLI only in male T2D before (ß = .116, p < .05), but not after adjustments for age and BMI (ß = .052; p = .30).
Steatosis risk correlates with lower thyroid function in T2D, which is mediated by insulin resistance and body mass, specifically in men, whereas no such relationship is present in T1D.
非酒精性脂肪性肝病（NAFLD）与 2 型糖尿病（T2D）有关，但也与甲状腺功能减退有关。然而，甲状腺功能与糖尿病患者中 NAFLD 的关系尚不清楚。本研究旨在探讨新发糖尿病患者中游离甲状腺素（fT4）或促甲状腺激素（TSH）与 NAFLD 之间的关系。
德国糖尿病研究（GDS）是一项前瞻性纵向队列研究，纳入了近期诊断的 1 型糖尿病（T1D，n=358）、2 型糖尿病（T2D，n=596）或无糖尿病（CON，n=175）患者，进行 Botnia 钳夹试验和游离甲状腺素、促甲状腺激素、脂肪性肝病指数（FLI）的检测，并在一个代表性亚组中进行 H 磁共振波谱分析。
首先，T1D 和 T2D 之间的 fT4 水平相似（p=0.55），但高于 CON（T1D：p<0.01；T2D：p<0.001），而 TSH 浓度在所有组之间无差异。其次，fT4 仅在 T2D 中与 FLI 呈负相关，与胰岛素敏感性呈正相关（β=-0.110，p<0.01；β=0.126，p<0.05），特别是在男性中（β=-0.117，p<0.05；β=0.162；p<0.01），调整年龄、性别和 BMI 后。然而，fT4 与 FLI 之间的相关性在调整胰岛素敏感性后失去统计学意义（T2D：β=-0.021，p=0.67；男性 T2D：β=-0.033；p=0.56）。TSH 仅在男性 T2D 中与 FLI 呈正相关，在调整年龄和 BMI 之前（β=0.116，p<0.05），但调整后（β=0.052；p=0.30）则无相关性。
在 T2D 中，脂肪变性的风险与较低的甲状腺功能相关，这与胰岛素抵抗和体重有关，特别是在男性中，而在 T1D 中则不存在这种关系。
