甲状腺功能正常患者甲状腺激素敏感性与代谢功能障碍相关脂肪性肝病的相关性

徐冰儿; 白子平; 张林杉; 常薪霞; 卞华

doi:10.12025/j.issn.1008-6358.2025.20250429

甲状腺功能正常患者甲状腺激素敏感性与代谢功能障碍相关脂肪性肝病的相关性

The correlation between thyroid hormone sensitivity and metabolic dysfunction-associated steatotic liver disease in patients with normal thyroid function

摘要

摘要:
目的探讨甲状腺功能正常患者甲状腺激素敏感性与代谢功能障碍相关脂肪性肝病（metabolic dysfunction-associated steatotic liver disease, MASLD）的相关性。
方法回顾性选择2016年1月至2020 年 12 月在复旦大学附属中山医院内分泌科住院的甲状腺功能正常患者，所有患者均检测游离三碘甲状腺原氨酸（free triiodothyronine, FT3）、游离甲状腺素（free thyroxine, FT4）及促甲状腺激素（thyroid-stimulating hormone, TSH），并计算FT3/FT4比值、促甲状腺激素指数（thyroid-stimulating hormone index, TSHI）、FT3反馈分位数指数（TFQIFT3）和FT4反馈分位数指数（TFIQFT4）。采用肝脏FibroScan检查评估入组患者的肝脏受控衰减参数（controlled attenuation parameter, CAP）和肝脏硬度值（liver stiffness measurement, LSM）。采用logistic回归模型分析甲状腺激素相关参数与MASLD的相关性。
结果共纳入4 869例患者，其中MASLD患者3 485例（71.58%）。与非MASLD组患者相比，MASLD组患者的血清FT3、FT3/FT4、TSHI、TFQIFT3和TFIQFT4均显著升高（P＜0.05）。对潜在混杂因素进行多变量调整后，血清FT3、FT3/FT4、TFQIFT4、TFQIFT3、TSHI与MASLD发病风险仍正相关（P＜0.05）。进一步分析显示，校正混杂因素后，FT3、FT3/FT4、TFQIFT4、TFQIFT3、TSHI与CAP正相关，TFQIFT4、TFQIFT3、TSHI与LSM正相关（P＜0.05）。
结论甲状腺激素敏感性的降低与MASLD发生独立相关；较高水平的FT3及甲状腺激素敏感性降低与MASLD的进展相关。

Abstract:
Objective To explore the correlation between thyroid hormone (TH) sensitivity and metabolic dysfunction-associated steatotic liver disease (MASLD) in euthyroid patients.
Methods The euthyroid patients hospitalized in the Department of Endocrinology at Zhongshan Hospital, Fudan University, from January 2016 to December 2020 were enrolled. All patients were evaluated for free triiodothyronine (FT3), free thyroxine (FT4), and thyroid-stimulating hormone (TSH). The FT3/FT4 ratio, thyroid-stimulating hormone index (TSHI), FT3 feedback quantile index (TFQIFT3), and FT4 feedback quantile index (TFIQFT4) were calculated. Hepatic controlled attenuation parameter (CAP) and liver stiffness measurement (LSM) were assessed by FibroScan.
Results A total of 4 869 participants were enrolled, 3 485 (71.58%) were diagnosed with MASLD. Compared with non-MASLD group of patients, MASLD group had significantly higher levels of serum FT3 and thyroid sensitivity-related parameters, including FT3/FT4, TSHI, TFQIFT3, and TFIQFT4 (P＜0.05). After multivariate adjustment for potential confounders, serum FT3, FT3/FT4, TFQIFT4, TFQIFT3, and TSHI remained positively correlated with the risk of MASLD (P＜0.05). Further analysis revealed that, after adjustment for confounders, FT3, FT3/FT4, TFQIFT4, TFQIFT3, and TSHI were positively correlated with CAP, and TFQIFT4, TFQIFT3, and TSHI were also positively correlated with LSM (P＜0.05).
Conclusions Reduced thyroid hormone sensitivity are independently associated with MASLD. Moreover, higher levels of FT3 and decreased thyroid hormone sensitivity are correlated with the progression of MASLD.

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