| Objective:In recent years,the prevalence rate of non-alcoholic fatty liver disease(NAFLD)continues to rise,and now it has replaced chronic hepatitis to become the first chronic liver disease in the world.NAFLD can not only develop into liver cirrhosis and even liver cancer,but also threaten human health.It is also closely related to many major diseases such as type 2 diabetes mellitus(T2DM),cardio-cerebrovascular diseases,chronic kidney disease and colorectal malignant tumors.Due to the occult onset of NAFLD and the lack of specific clinical manifestations in the early stage,it is often unable to be detected in time,resulting in the progression of the disease.At present,there is a lack of effective methods for the treatment of NAFLD,mainly based on prevention,so early detection has a high practical value.There are many risk factors for NAFLD.In recent years,many studies have shown that hypothyroidism and subclinical hypothyroidism are related to the pathogenesis of NAFLD.However,there is no consistent conclusion about the correlation between thyroid hormone level and NAFLD in people with normal thyroid function.Because of the common pathological basis of T2 DM and NAFLD,the prevalence rate of NAFLD in T2 DM population is higher.The purpose of this study is to explore the risk factors of T2 DM patients with normal thyroid function complicated with NAFLD and the correlation between serum thyroid hormone levels and NAFLD,so as to make a more accurate screening of T2 DM patients with NAFLD,so as to achieve early detection,early intervention and delay the progress of the disease.Method:In this study,T2 DM patients with normal nail function who were hospitalized in the Endocrinology Department of the First Hospital of Yulin City from July 1,2017 to June 30,2019 were used as the research subjects.Strictly follow the inclusion and exclusion criteria,all the eligible subjects in the hospital HIS system were collected for data collection.All the participants were informed and approved by the Ethics Committee of the first Hospital of Yulin City.Relevant data collected include sex,age,height,weight,body mass index(BMI),systolic blood pressure(SBP),diastolic blood pressure(DBP),white blood cell count(WBC),glycosylated hemoglobin(HbA1c),aspartate aminotransferase(AST),alanine aminotransferase(ALT),γ-glutamyltransferase(GGT),blood urea nitrogen(BUN),serum creatinine(Scr),uric acid(UA),total cholesterol(TCHO),triglycerides(TG),high density lipoprotein cholesterol(HDL-C),low density lipoprotein cholesterol(LDL-C),apolipoprotein A(APOA),apolipoprotein B(APOB),thyroid stimulating hormone(TSH),free triiodothyronine(FT3),free thyroxine(FT4).Refer to the reference value of normal thyroid function index in our hospital,that is,0.27≤TSH≤4.5uIU/ml,1.86≤FT3≤6.44pmol/L,11.45≤FT4≤22.14 pmol/L,Whether complicated with diabetic nephropathy(DN),diabetic retinopathy(DR),cervical atherosclerotic(CAS),diabetic peripheral neuropathy(DPN).SPSS25.0 software was used for statistical analysis.The measurement data of normal distribution were expressed as mean ±standard deviation,and t-test was used for comparison between groups.The measurement data that do not meet the normal distribution are expressed by median and quartile spacing,and the Mann-Whitney U test is used for inter-group comparison.The counting data is expressed as a percentage,and the chi-square test is used for the comparison of counting data rates.The correlation between thyroid hormone level and each index was analyzed by Spearman correlation analysis,Logistic regression was used for multivariate analysis,and ROC curve analysis was used to determine the efficacy of FT3 in predicting the risk of NAFLD in patients with T2 DM.The statistical test level was α = 0.05.Result:1.According to the inclusion and exclusion criteria,a total of 931 subjects met the requirements,ranging in age from 19 to 82 years old,with an average age of 52.61 ±11.51 years old,617 males(66.3%)and 314 females(33.7%).In the included population,a total of 501 cases met the diagnostic criteria of NAFLD,accounting for about 53.8%,which was defined as the merger group.A total of 430 cases did not meet the diagnostic criteria of NAFLD,accounting for about46.2%,which was defined as the control group.The results showed that the levelsof BMI,SBP,DBP,HbA1 c,ALT,AST,GGT,UA,TCHO,TG,LDL-C and APOB in the combined group were significantly higher than those in the control group,while the age,course of T2 DM,HDL-C,β 2-MGand Cys-C were significantly lower than those in the control group.Among the indexes related to thyroid function,the FT3 of the combined group was significantly higher than that of the control group,but there was no significant difference in FT4 and TSH between the two groups.2.The correlation between thyroid hormone level and metabolic indexwas analyzed by Spearman.The results showed that FT3 level was positively correlated with BMI,DBP,ALT AST GGT Scr LDL-C UA and TG,and negatively correlated with HbA1 c and Cys-C.FT4 was positively correlated with BMI,DBP and LDL-C,and negatively correlated with ALT,AST and Cys-C.TSH waspositively correlated with AST and negatively correlated with HbA1 c and Cys-C.3.According to the quartile spacing of FT3,FT4 and TSH,the enrolled people were dividedinto four groups.The results of comparing the prevalence rate of NAFLD among the four groups showed that the prevalence rate of FT3 with NAFLD fromQ1~Q4 in different quantiles showed an increasing trend(P < 0.001),which were 42.7%,52.4%,55.2%,65.1%,respectively.However,there was no significant difference in the prevalence of NAFLD among different quantiles of TSH and FT4.Univariate Logistic regression analysis showed that the risk of NAFLD in people with FT3 from Q2 to Q4 was higher than that in Q1 [Q2:OR=1.474,95% Cl=1.023~2.125,Q3:OR=1.656,95% Cl=1.151~2.384,Q4:OR= 2.496,95% Cl=1.715~3.633].4.Multivariate Logistic analysis showed that FT3 was an risk factor(OR:1.391,95%Cl:1.027~1.885,P=0.036)for T2 DM patients with NAFLD.Other independent influence factors included BMI(OR:1.278,95%Cl:1.196~1.366,P<0.001),DBP(OR:1.032,95%Cl:1.012~1.052,P=0.002)and TG(OR:1.482,95%Cl:1.214~1.809,)P<0.001),UA(OR:1.004,95%Cl:1.001~1.006,P=0.008),and the course of T2DM(OR:0.954,95%Cl:0.922~0.998,P=0.008).5.The results showed that FT3 was of some value in the diagnosis of NAFLD in patients with T2DM(AUC=0.594;95%Cl0.558~0.630;P < 0.001).The best tangent value is: FT3=3.905;sensitivity = 70.5%;specificity = 45.6%.The combination of FT3 and BMI,T2 DM course,DBP,TG,UA can improve the diagnostic value of NAFLD.Conclusion: 1.The risk of NAFLD in T2 DM patients with normal thyroid function was positively correlated with the level of FT3,but not with the level of FT4 and TSH.2.After correction of confounding factors,it was still shown that FT3 was a risk factor for T2 DM patients with NAFLD,and other influencing factors included BMI,DBP,TG,UA and the course of T2 DM.3.FT3 has a some diagnostic value in patients with T2 DM complicated with NAFLD.The combination of FT3 with BMI,T2 DM course,DBP and TG can improve the diagnostic value of NAFLD. |
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