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第41卷第3期 南京医科大学学报(自然科学版)
2021年3月 Journal of Nanjing Medical University(Natural Sciences) ·369 ·
·临床研究·
中老年人促甲状腺素水平与新发非酒精性脂肪性肝病的相关
性研究
刘丽娟,甄东户,汤旭磊 ,傅松波,杨晓梅,马小妮
*
兰州大学第一医院内分泌科,甘肃 兰州 730000
[摘 要] 目的:分析兰州市社区中老年人群促甲状腺素(thyroid stimulating hormone,TSH)水平与3年随访时新发非酒精性
脂肪性肝病(non⁃alcoholic fatty liver disease,NAFLD)的相关性。方法:选取兰州市社区2011年基线调研时40~75岁甲状腺功
能(甲功)正常(727例)及亚临床甲状腺功能减退症(亚临床甲减,222例)的无脂肪肝人群,于2014年进行随访,采集人体学指
标,检测甲状腺激素水平、血糖、血脂、肝酶等,并检查上腹部超声。结果:亚临床甲减3年缓解率为27.93%(62/222);基线甲功
正常人群中亚临床甲减3年新发率为16.64%(121/727)。随着基线TSH水平的升高,总胆固醇(total cholesterol,TC)、甘油三酯
(triglyceride,TG)、低密度脂蛋白胆固醇(low density lipoprotein cholesterol,LDL⁃C)、天门冬氨酸氨基转移酶(aspartate amino⁃
transferase,AST)水平逐渐升高(P均<0.05)。仅在女性中,不同基线TSH水平人群NAFLD 3年发病率差异有统计学意义(P <
0.05)。Logistic 回归分析显示,女性中,在模型1未校正及模型2校正年龄、基线体重指数(body mass index,BMI)、基线TG、基
线糖化血红蛋白(HbA1c)后,基线 TSH 与 NAFLD 3 年发病风险呈正相关(P 均<0.05);在模型 3 进一步校正 BMI 差值、HbA1c
差值后,二者的相关性无统计学意义。结论:中老年女性中,基线 TSH 水平是 NAFLD 3 年发病的影响因素,但二者无独立
相关性。
[关键词] 促甲状腺素;非酒精性脂肪性肝病;发病率
[中图分类号] R575.5 [文献标志码] A [文章编号] 1007⁃4368(2021)03⁃369⁃06
doi:10.7655/NYDXBNS20210310
Association between thyroid stimulating hormone and incident non ⁃ alcoholic fatty liver
disease in middle⁃aged and elderly population
*
LIU Lijuan,ZHEN Donghu,TANG Xulei ,FU Songbo,YANG Xiaomei,MA Xiaoni
Department of Endocrinology,the First Hospital of Lanzhou University,Lanzhou 730000,China
[Abstract] Objective: The objective of the study was to investigate the association between thyroid stimulating hormone(TSH)and
incident non⁃alcoholic fatty liver disease(NAFLD)in middle⁃aged and elderly population in a 3⁃year follow⁃up study. Methods:Total
222 subclinically hypothyroid(TSH>4.50 mU/L)and 727 euthyroid people aged 40~75 years who were free of fatty liver disease at
baseline in a community were included in the current study. The study population was screened initially in 2011 and re⁃evaluated in
2014. On both occasions they were assessed by structured interview via a questionnaire on general information,anthropometric
measurements,thyroid hormones,biochemical and serological tests,liver ultrasound. Results:Among 222 baseline subclinical
hypothyroidism patients,62(27.93%) reverted to euthyroidism at a 3 ⁃ year follow ⁃ up. The 3 ⁃ year incidence of subclinical
hypothyroidism was 16.64%(121/727). Higher TSH levels at baseline were associated with higher total cholesterol(TC),triglyceride
(TG),low density lipoprotein cholesterol(LDL⁃C)and aspartate aminotransferase(AST)levels(P < 0.05). The incidence rate of
NAFLD increased with increasing baseline TSH levels in female(P < 0.05). Logistic regression analyses showed,higher baseline TSH
levels were associated with the diagnosis of NAFLD by unadjusted in model 1 in female. After adjustment for age,baseline BMI,
baseline TG,baseline HbA1c in model 2,this association remained significant. When data were adjusted for the changes in BMI and
[基金项目] 甘肃省卫生行业科研计划(GSWSKY⁃2014⁃27,GSWST2010⁃03);甘肃省自然科学基金计划项目(1606RJZA347);
标准化代谢性疾病管理中心(MMC)专项研究基金(2018⁃mmczxjj⁃3)
∗
通信作者(Corresponding author),E⁃mail: xulei_tang@126.com