2型糖尿病合并非酒精性脂肪性肝病患者肝纤维化与血尿酸水平的关系

刘婷; 王臣廷; 刘美晓; 刘建凤; 郑少雄

doi:10.3969/j.issn.1001-5256.2020.06.026

2型糖尿病合并非酒精性脂肪性肝病患者肝纤维化与血尿酸水平的关系

DOI: 10.3969/j.issn.1001-5256.2020.06.026

1. 承德医学院研究生学院
2. 承德医学院附属沧州市人民医院内分泌代谢科
3. 沧州医学高等专科学校解剖教研室
4. 天津医科大学第二医院内分泌科

基金项目:

河北省教育厅在读研究生创新能力培养资助项目(CXZZSS2020132)；

详细信息

中图分类号: R575.5;R587.1
计量
- 文章访问数: 1132
- HTML全文浏览量: 23
- PDF下载量: 185
- 被引次数: 0
出版历程
- 出版日期: 2020-06-20

Association between liver fibrosis and serum uric acid in patients with type 2 diabetes mellitus and nonalcoholic fatty liver disease

Research funding:

摘要

摘要:
目的探讨2型糖尿病（T2DM）合并非酒精性脂肪性肝病（NAFLD）患者肝纤维化与血尿酸水平的关系。方法选取2018年1月-2019年8月在沧州市人民医院就诊的T2DM合并NAFLD患者328例,应用NAFLD纤维化评分（NFS）联合FIB-4评估肝纤维化风险,分为肝纤维化低危组（136例）、肝纤维化中危组（145例）及肝纤维化高危组（47例）;另选取资料匹配的T2DM患者141例为对照。比较各组血尿酸水平的差异。计量资料多组间比较采用单因素方差分析或Kruskal-Wallis H检验;计数资料组间比较采用χ2检验。采用logistic回归法分析肝纤维化的影响因素。绘制受试者工作曲线（ROC）评价危险因素的预测效能。结果与T2DM组相比,T2DM合并NAFLD组血尿酸水平显著升高,差异有统计学意义（265. 00±77. 01 vs 313. 04±100. 90,t=-5. 619,P<0. 001）。与肝纤维化低危组（290. 70±95. 46）和中危组（328. 15±90. 85）相比,肝纤维化高危组患者（392. 77±108. 37）血尿酸水...
- 糖尿病,2型 /
- 非酒精性脂肪性肝病 /
- 肝硬化 /
- 血尿酸
Abstract:
Objective To investigate the association between liver fibrosis and serum uric acid in patients with type 2 diabetes mellitus( T2 DM) and nonalcoholic fatty liver disease( NAFLD). Methods A total of 328 patients with T2 DM and NAFLD who attended Cangzhou People's Hospital from January 2018 to August 2019 were enrolled,and according to NAFLD fibrosis score( NFS) and fibrosis-4( FIB-4)index,they were divided into low-risk fibrosis group with 136 patients,intermediate-risk fibrosis group with 145 patients,and high-risk fibrosis group with 47 patients. A total of 141 patients with T2 DM,matched for age and sex,were enrolled as T2 DM group. Serum uric acid was compared between groups. A one-way analysis of variance or the Kruskal-Wallis H test was used for comparison of continuous data between multiple groups,and the chi-square test was used for comparison of categorical data between groups. A logistic regression analysis was used to determine the influencing factors for liver fibrosis,and the receiver operating characteristic( ROC) curve was used to evaluate the predictive efficiencies of risk factors. Results Compared with the T2 DM group,the T2 DM + NAFLD group had a significant increase in serum uric acid( 313. 04 ± 100. 90 vs 265. 00 ± 77. 01,t =-5. 619,P < 0. 001). The high-risk fibrosis group had a significant increase in serum uric acid compared with the low-risk fibrosis group( 392. 77 ± 108. 37 vs 290. 70 ± 95. 46,P < 0. 05) and the intermediate-risk fibrosis group( 392. 77 ± 108. 37 vs 328. 15 ± 90. 85,P < 0. 05),and the high-risk fibrosis group had a significantly higher prevalence rate of hyperuricemia than the low-risk fibrosis group and the intermediate-risk fibrosis group( 47. 00% vs 11. 72% vs 11. 76%,P < 0.01). The logistic regression analysis showed that serum uric acid( odds ratio = 1. 133,95% confidence interval: 1. 064-1. 312) was an independent risk factor for liver fibrosis in patients with T2 DM and NAFLD. The ROC curve showed that serum uric acid had a certain value in predicting liver fibrosis,with an area under the ROC curve of 0. 745. Conclusion The high level of serum uric acid is an independent risk factor for the development and progression of liver fibrosis in patients with T2 DM and NAFLD.
- diabetes mellitus,type 2 /
- nonalcoholic fatty liver disease /
- liver cirrhosis /
- uric acid

HTML全文

参考文献(21)

[1] LONARDO A,BELLENTANI S,ARGO CK,et al. Epidemiological modifiers of non-alcoholic fatty liver disease:Focus on high-risk groups[J]. Dig Liver Dis,2015,47(12):997-1006.

[2] ZHAO CC,WANG AP,LI LX,et al. Urine uric acid excretion is associated with nonalcoholic fatty liver disease in patients with type 2 diabetes[J]. J Diabetes Complications,2016,30(6):1074-1080.

[3] YU L,FENG C,JIANG YM,et al. Changes and significance of homocysteine,total cholesterol and serum uric acid in patients with type 2 diabetes mellitus[J]. Clin J Med Offic,2019,47(12):1355-1356.(in Chinese)俞琳，冯晨，蒋艳敏，等．同型半胱氨酸、总胆固醇及血尿酸在2型糖尿病患者血清中变化及意义[J]．临床军医杂志，2019,47(12):1355-1356.

[4] Multi-disciplinary expert task force on hyperuricemia and its related diseases. Chinese multi-disciplinary consensus on the diagnosis and treament of hyperuricemia and its related diseases[J]. Chin J Intern Med,2017,56(3):235-248.(in Chinese)高尿酸血症相关疾病诊疗多学科共识专家组．中国高尿酸血症相关疾病诊疗多学科专家共识[J]．中华内科杂志，2017,56(3):235-248.

[5] LIN H,LI Q,LIU X,et al. Liver fat content is associated with elevated serum uric acid in the Chinese middle-aged and elderly populations:Shanghai changfeng study[J]. PLo S One,2015,10(10):e140379.

[6] CAI W,WENG DH,DONG HZ,et al. Prospective cohort study on the predictive value of serum uric acid levels to the incident nonalcoholic fatty liver disease[J]. Chin Endocrinol Metab,2017,33(3):203-207.(in Chinese)蔡雯，翁迪华，董正惠，等．血尿酸水平预测非酒精性脂肪性肝病的前瞻性队列研究[J]．中华内分泌代谢杂志，2017,33(3):203-207.

[7] ALBERTI KG,ZIMMET PZ. Definition,diagnosis and classification of diabetes mellitus and its complications. Part 1:Diagnosis and classification of diabetes mellitus provisional report of a WHO consultation[J]. Diabet Med,1998,15(7):539-553.

[8] Chinese Society of Hepatology,Department of Fatty Liver and Alcoholic Liver Disease,Chinese Medical Association,Expert Committee on Fatty Liver Diseases. The guidelines of prevention and treatment for nonalcoholic fatty liver diseases(Updated 2018)[J]. J Clin Hepatol,2018,34(5):947-957.(in Chinese)中华医学会肝病学分会脂肪肝和酒精性肝病学组，中国医师协会脂肪性肝病专家委员会．非酒精性脂肪性肝病防治指南(2018年更新版)[J]．临床肝胆病杂志，2018,34(5):947-957.

[9] McPHERSON S,HARDY T,DUFOUR JF,et al. Age as a confounding factor for the accurate non-invasive diagnosis of advanced NAFLD fibrosis[J]. Am J Gastroenterol,2017,112(5):740-751.

[10] TILG H,MOSCHEN AR. Evolution of inflammation in nonalcoholic fatty liver disease:The multiple parallel hits hypothesis[J]. Hepatology,2010,52(5):1836-1846.

[11] ANGULO P,HUI JM,MARCHESINI G,et al. The NAFLD fibrosis score:A noninvasive system that identifies liver fibrosis in patients with NAFLD[J]. Hepatology,2007,45(4):846-854.

[12] YANG LH,LIAO X,ZHANG H,et al. Relationship between liver fibrosis and serum 25-(OH)D in patients with type 2 diabetes and nonalcoholic fatty liver disease[J]. Chin J Diabetes,2018,26(2):117-122.(in Chinese)杨丽弘，廖鑫，张晗，等．2型糖尿病合并非酒精性脂肪肝肝纤维化与血清25-羟维生素D水平的关系研究[J]．中国糖尿病杂志，2018,26(2):117-122.

[13] ZHANG XE,QU S. Recognizing hyperuricemia from the viewpoint of the inflammation[J]. Chin Endocrinol Metab,2019,35(8):718-722.(in Chinese)张玄娥，曲伸．高尿酸血症的现代进化与多重性作用———从炎症角度审视高尿酸血症[J]．中华内分泌代谢杂志，2019,35(8):718-722.

[14] BALLESTRI S,NASCIMBENI F,ROMAGNOLI D,et al. The independent predictors of non-alcoholic steatohepatitis and its individual histological features. Insulin resistance,serum uric acid,metabolic syndrome,alanine aminotransferase and serum total cholesterol are a clue to pathogenesis and candidate targets for treatment[J]. Hepatol Res,2016,46(11):1074-1087.

[15] QIU JS,ZHOU ZY,ZHANG WH,et al. Uric acid induces endothelial dysfunction through inflammatory mediators in patients with type 2 diabetes mellits[J]. Chin J Immunol,2019,35(18):2267-2271.(in Chinese)邱杰山，周子英，张文华，等．2型糖尿病患者高尿酸血症与血管内皮细胞功能损伤关系的研究[J]．中国免疫学杂志，2019,35(18):2267-2271.

[16] ZHANG X,ZHANG JH,CHEN XY,et al. Reactive oxygen species-induced TXNIP drives fructose-mediated hepatic inflammation and lipid accumulation through NLRP3 inflammasome activation[J]. Antioxid Redox Signal,2015,22(10):848-870.

[17] LANASPA MA,SANCHEZ-LOZADA LG,CHOI YJ,et al. Uric acid induces hepatic steatosis by generation of mitochondrial oxidative stress:Potential role in fructose-dependent and-independent fatty liver[J]. J Biol Chem,2012,287(48):40732-40744.

[18] SANCHEZ-VALLLE V,CHAVEZ-TAPIA NC,URIBE M,et al. Role of oxidative stress and molecular changes in liver fibrosis:a review[J]. Curr Med Chem,2012,19(28):4850-4860.

[19] WAN X,XU C,LIN Y,et al. Uric acid regulates hepatic steatosis and insulin resistance through the NLRP3 inflammasome-dependent mechanism[J]. J Hepatol,2016,64(4):925-932.

[20] ZAHO J,QI YF,YU YR. Research advances in the role of oxidative stress in the development and progression of liver fibrosis[J]. J Clin Hepatol,2019,35(9):2067-2071.(in Chinese)赵杰，齐永芬，鱼艳荣．氧化应激在肝纤维化发生发展中的作用[J]．临床肝胆病杂志，2019,35(9):2067-2071.

[21] SANDAR S,LESMANA C,PURNAMASARI D,et al. Hyperuricemia as an independent risk factor for non-alcoholic fatty liver disease(NAFLD)progression evaluated using controlled attenuation parameter-transient elastography:Lesson learnt from tertiary referral center[J]. Diabetes Metab Syndr,2019,13(1):424-428.

施引文献

资源附件(0)

访问统计