Correlation between thyroid hormone sensitivity and non-alcoholic fatty liver in type 2 diabetes mellitus patients with normal thyroid function

doi:10.3969/j.issn.1004-583X.2025.02.006

Abstract

Abstract:

Objective To analyze the correlation between thyroid hormone sensitivity and non-alcoholic fatty liver disease (NAFLD) in type 2 diabetes mellitus (T2DM) patients with normal thyroid function. Methods This was a cross-sectional study. A retrospective analysis was performed to assess 330 T2DM patients with normal thyroid function who were hospitalized in the Department of Endocrinology, the Fifth Affiliated Hospital of Zhengzhou University from December 2023 to May 2024. According to the presence or absence of NAFLD, the patients were divided into NAFLD group (n=112) and non-NAFLD group (n=218). All patients underwent examinations like abdominal ultrasound, blood biochemistry, visceral fat area (VFA), and abdominal subcutaneous fat area (SFA). The correlations between the thyroid feedback quantile-based Index (TFQI), thyrotroph thyroxine resistance index (TT4RI), thyroid-stimulating hormone index (TSHI), free triiodothyronine/free thyroxine (FT3/FT4) with NAFLD were explored. Results Compared with non-NAFLD group, in NAFLD group had significantly higher proportions of smokers, and higher levels of body weight, body mass index, VFA, SFA, systolic/ diastolic blood pressure, fasting plasma glucose (FPG), glycosylated hemoglobin (HbA₁c), total cholesterol (TC), triglyceride (TG), low density lipoprotein cholesterol (LDL-C), FT3, TFQI, and FT3/FT4 (P<0.05), and significantly lower level of high density lipoprotein cholesterol (HDL-C) (P<0.05). Spearman correlation analysis showed that TFQI was positively correlated with TG and LDL-C (P<0.05), and negatively correlated with HDL-C (P<0.05). TT4RI was positively correlated with TC, TG, FPG, and HbA₁c (P<0.05). TSHI was positively correlated with TC, TG, FPG, and HbA₁c (P<0.05). FT3/FT4 was positively correlated with TC, TG, LDL-C, FPG, and HbA₁c. Multivariate logistic regression analysis showed that TG, VFA, HbA₁c, and FT3/FT4 were independent risk factors for the occurrence of NAFLD in T2DM patients (P<0.01). By drawing the receiver operating characteristic curve, it was found that the area under the curve of FT3/FT4 for evaluating NAFLD in T2DM patients was 0.679, with a sensitivity of 70.47% and a specificity of 65.09%. Conclusion An increase in FT3/FT4 in T2DM patients with normal thyroid function is associated with an increased risk of NAFLD.

Key words: diabetes mellitus, type 2, non-alcoholic fatty liver disease, thyroid hormones, thyroid hormone sensitivity

CLC Number:

R587.1

Shi Shuangwei, Rao Xiaojuan, Xie Liran, Fang Yifan, Wang Shanshan. Correlation between thyroid hormone sensitivity and non-alcoholic fatty liver in type 2 diabetes mellitus patients with normal thyroid function[J]. Clinical Focus, 2025, 40(2): 133-137.

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URL: http://www.lchc.cn/EN/10.3969/j.issn.1004-583X.2025.02.006

http://www.lchc.cn/EN/Y2025/V40/I2/133

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References 20

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组别	例数	男性 [例(%)]		年龄 (岁)		吸烟史 [例(%)]		糖尿病病程 (年)	身高 (cm)
非NAFLD组	218	121(55.5)		54.24±6.31		54(24.8)		13.24±3.82	167.60±2.74
NAFLD组	112	61(54.5)		52.60±4.73		32(28.6)		12.09±4.28	168.02±5.28
t/χ²值		0.434		0.612		2.034		0.732	0.719
P值		0.502		0.409		0.031		0.315	0.321
组别	体重(kg)		BMI(kg/m²)		VFA(cm²)		SFA(cm²)	收缩压(mmHg)	舒张压(mmHg)
非NAFLD组	67.60±8.20		22.09±3.48		93.94±12.75		164.75±17.20	123(102, 145)	67(56, 83)
NAFLD组	74.03±4.29		27.04±5.25		123.05±17.39		234.04±21.47	143(127, 157)	92(73, 103)
t/Z值	1.204		2.044		3.173		4.923	1.045	0.983
P值	0.000		0.000		0.000		0.000	0.015	0.026

组别	例数	男性 [例(%)]		年龄 (岁)		吸烟史 [例(%)]		糖尿病病程 (年)	身高 (cm)
非NAFLD组	218	121(55.5)		54.24±6.31		54(24.8)		13.24±3.82	167.60±2.74
NAFLD组	112	61(54.5)		52.60±4.73		32(28.6)		12.09±4.28	168.02±5.28
t/χ²值		0.434		0.612		2.034		0.732	0.719
P值		0.502		0.409		0.031		0.315	0.321
组别	体重(kg)		BMI(kg/m²)		VFA(cm²)		SFA(cm²)	收缩压(mmHg)	舒张压(mmHg)
非NAFLD组	67.60±8.20		22.09±3.48		93.94±12.75		164.75±17.20	123(102, 145)	67(56, 83)
NAFLD组	74.03±4.29		27.04±5.25		123.05±17.39		234.04±21.47	143(127, 157)	92(73, 103)
t/Z值	1.204		2.044		3.173		4.923	1.045	0.983
P值	0.000		0.000		0.000		0.000	0.015	0.026

组别	例数	FPG (mmol/L)		HbA₁c (%)		TC (mmol/L)	TG (mmol/L)	HDL-C (mmol/L)		LDL-C (mmol/L)		FT3 (pmol/L)
非NAFLD组	218	6.02±0.29		6.71±0.03		4.62±0.63	1.07±0.21	1.46±0.23		2.96±0.27		4.28±0.19
NAFLD组	112	6.94±1.03		7.42±0.24		5.07±0.38	1.46±0.17	1.17±0.37		3.14±0.30		4.56±0.24
t值		2.731		1.983		1.834	2.381	3.401		4.903		0.891
P值		0.000		0.001		0.013	0.000	0.000		0.000		0.032
组别	FT4 (pmol/L)		TSH (mU/L)		TFQI		TT4RI		TSHI		FT3/FT4
非NAFLD组	13.45±0.35		1.85±0.35		-0.02(-0.31, 0.27)		26.53(21.54, 35.34)		2.07(0.68, 1.72)		0.32(0.17, 0.42)
NAFLD组	13.62±0.25		1.90±0.41		0.02(-0.19, 0.31)		27.45(22.27, 34.62)		1.98(0.62, 1.65)		0.34(0.19, 0.41)
t/Z值	0.136		0.472		1.389		0.372		0.419		3.274
P值	0.732		0.082		0.029		0.062		0.073		0.000

组别	例数	FPG (mmol/L)		HbA₁c (%)		TC (mmol/L)	TG (mmol/L)	HDL-C (mmol/L)		LDL-C (mmol/L)		FT3 (pmol/L)
非NAFLD组	218	6.02±0.29		6.71±0.03		4.62±0.63	1.07±0.21	1.46±0.23		2.96±0.27		4.28±0.19
NAFLD组	112	6.94±1.03		7.42±0.24		5.07±0.38	1.46±0.17	1.17±0.37		3.14±0.30		4.56±0.24
t值		2.731		1.983		1.834	2.381	3.401		4.903		0.891
P值		0.000		0.001		0.013	0.000	0.000		0.000		0.032
组别	FT4 (pmol/L)		TSH (mU/L)		TFQI		TT4RI		TSHI		FT3/FT4
非NAFLD组	13.45±0.35		1.85±0.35		-0.02(-0.31, 0.27)		26.53(21.54, 35.34)		2.07(0.68, 1.72)		0.32(0.17, 0.42)
NAFLD组	13.62±0.25		1.90±0.41		0.02(-0.19, 0.31)		27.45(22.27, 34.62)		1.98(0.62, 1.65)		0.34(0.19, 0.41)
t/Z值	0.136		0.472		1.389		0.372		0.419		3.274
P值	0.732		0.082		0.029		0.062		0.073		0.000

项目		TFQI	TT4RI	TSHI	FT3/FT4
TC	r_s	0.008	0.106	0.137	0.128
	P	0.410	<0.001	<0.001	<0.001
TG	r_s	0.093	0.063	0.017	0.029
	P	<0.001	0.015	0.001	0.004
HDL-C	r_s	-0.084	0.019	0.035	0.034
	P	<0.001	0.062	0.073	0.071
LDL-C	r_s	0.048	0.018	0.090	0.385
	P	<0.01	0.065	0.073	<0.001
FPG	r_s	-0.003	0.025	0.020	0.170
	P	0.769	0.012	0.040	0.002
HbA₁c	r_s	0.040	0.027	0.097	0.445
	P	0.356	0.010	<0.001	<0.001