血清尿酸/肌酐比值与非酒精性脂肪性肝病的相关性分析

邵翠萍; 徐有青

doi:10.3969/j.issn.1001-5256.2021.10.018

血清尿酸/肌酐比值与非酒精性脂肪性肝病的相关性分析

DOI: 10.3969/j.issn.1001-5256.2021.10.018

邵翠萍,
徐有青^,

首都医科大学附属北京天坛医院消化内科，北京 100070

基金项目:

国家科技重大专项课题 (2016ZX10002011)

详细信息

通信作者:
徐有青，youqingxuttyy@163.com

中图分类号: R575.5
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出版历程
- 收稿日期: 2021-02-03
- 录用日期: 2021-02-23
- 出版日期: 2021-10-20

Association of serum uric acid-to-creatinine ratio with nonalcoholic fatty liver disease

Cuiping SHAO,
Youqing XU^,

Department of Gastroenterology, Beijing Tiantan Hospital, Capital Medical University, Beijing 100070, China

Research funding:

National Science and Technology Major Project (2016ZX10002011)

摘要

摘要: 目的探讨血清尿酸(sUA)/肌酐(Cr)比值和非酒精性脂肪性肝病(NAFLD)的相关性。方法回顾性选取2020年1月— 2020年12月就诊于首都医科大学附属北京天坛医院的97例NAFLD患者(NAFLD组)，根据腹部超声检查结果将NAFLD患者分为轻度(n=33)、中度(n=31)、重度(n=33)3组。另选取同期于本院体检的36例健康成人作为对照组。比较各组间性别、年龄、空腹血糖(FBS)、ALT、AST、TC、TG、高密度脂蛋白(HDL)、低密度脂蛋白(LDL)、GGT、sUA、sCr、sUA/Cr水平。正态分布的计量资料2组间比较采用独立样本t检验，3组间比较采用方差分析；非正态分布计量资料组间比较采用Mann-Whitney U检验；计数资料组间比较采用χ²检验。相关性分析采用Spearman检验；采用多因素logistic回归分析NAFLD相关的危险因素。结果 NAFLD组ALT、AST、TG、GGT、sUA、sUA/Cr水平均显著高于健康对照组(Z=-4.881、Z=-4.616、Z=-4.221、Z=-3.563、t=12.974、t=10.710，P值均＜0.05)，而HDL水平则显著低于健康对照组(Z=-5.682，P＜0.05)。NAFLD的脂肪肝严重程度(轻中重)与ALT、TC、LDL呈正相关(r值分别为0.291、0.272、0.253，P值均＜0.05)。多因素logistic回归分析结果显示，sUA/Cr是发生NAFLD的独立危险因素(OR=1.885，95%CI：1.162~3.060，P＜0.05)。结论 sUA/Cr与NAFLD具有显著相关性，是NAFLD发生的独立预测因素。可以通过监测sUA/Cr的水平来预测NAFLD的发生，以期早发现、早诊断、早治疗，从而改善预后。
- 非酒精性脂肪性肝病 /
- 尿酸 /
- 肌酐
Abstract: Objective To investigate the association of serum uric acid (sUA)-to-creatinine (Cr) ratio with nonalcoholic fatty liver disease (NAFLD). Methods A retrospective analysis was performed for the clinical data of 97 patients with NAFLD (NAFLD group) who attended Beijing Tiantan Hospital, Capital Medical University, from January to December 2020, and according to the results of abdominal ultrasound, they were divided into mild group with 33 patients, moderate group with 31 patients, and severe group with 33 patients. Related data were also collected from 36 healthy adults (control group) who underwent physical examination in our hospital during the same period of time. The above groups were compared in terms of sex, age, fasting blood glucose, alanine aminotransferase (ALT), aspartate aminotransferase (AST), total cholesterol (TC), triglyceride (TG), high-density lipoprotein (HDL), low-density lipoprotein (LDL), gamma-glutamyl transpeptidase (GGT), sUA, serum Cr, and sUA/Cr ratio. The independent samples t- test was used for comparison of normally distributed continuous data between two groups, and an analysis of variance was used for comparison between three groups; the Mann-Whitney U test was used for comparison of non-normally distributed continuous data between groups; the chi-square test was used for comparison of categorical data between groups. The Spearman test was used for correlation analysis, and a multivariate logistic regression analysis was used to investigate the risk factors for NAFLD. Results Compared with the control group, the NAFLD group had significantly higher levels of ALT, AST, TG, GGT, sUA, and sUA/Cr ratio (Z=-4.881, -4.616, -4.221, and -3.563, t=12.974 and 10.710, all P < 0.05) and a significantly lower level of HDL (Z=-5.682, P < 0.05). The severity of NAFLD (mild, moderate or severe) was positively correlated with ALT, TC, and LDL (r=0.291, 0.272, and 0.253, all P < 0.05). The multivariate logistic regression analysis showed that sUA/Cr ratio was an independent risk factor for NAFLD (odds ratio=1.885, 95% confidence interval: 1.162-3.06, P < 0.05). Conclusion There is a significant correlation between sUA/Cr ratio and NAFLD, and sUA/Cr ratio is an independent predictive factor for NAFLD. The sUA/Cr ratio can be monitored to predict the onset of NAFLD, so as to achieve early identification, early diagnosis, and early treatment and improve prognosis.
- Non-Alcoholic Fatty Liver Disease /
- Uric Acid /
- Creatinine

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表 1 NAFLD组与健康对照组临床资料比较

项目	NAFLD组(n=97)	健康对照组(n=36)	统计值	P值
男性[例(%)]	62(63.9)	25(69.4)	χ²=0.354	0.682
年龄(岁)	44(34~55)	39(34~52)	Z=-1.353	0.176
FBS(mmol/L)	5.15(4.69~6.28)	5.05(4.78~5.39)	Z=-1.473	0.141
ALT(U/L)	36.7(21.5~58.6)	14.6(11.6~20.0)	Z=-4.881	＜0.001
AST(U/L)	23.6(18.4~35.7)	15.6(13.5~17.8)	Z=-4.616	＜0.001
TC(mmol/L)	4.53(3.66~5.37)	4.67(3.88~5.23)	Z=-0.765	0.444
TG(mmol/L)	1.71(1.03~2.72)	0.95(0.62~1.32)	Z=-4.221	＜0.001
HDL(mmol/L)	1.14(1.00~1.38)	1.58(1.43~1.88)	Z=-5.682	＜0.001
LDL(mmol/L)	2.70±0.97	2.69±0.93	t=0.003	0.958
GGT(U/L)	39.46(20.31~55.72)	19.21(11.95~31.05)	Z=-3.563	＜0.001
sUA(μmmol/L)	363.46±95.75	294.27±92.36	t=12.974	＜0.001
sCr(μmmol/L)	63.20±19.19	58.37±14.93	t=1.723	0.192
sUA/Cr	6.04±1.60	5.05±1.11	t=10.710	0.001

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表 2 轻中重度NAFLD患者临床资料比较

项目	轻度NAFLD组(n=33)	中度NAFLD组(n=31)	重度NAFLD组(n=33)	统计值	P值
男性[例(%)]	23(69.7)	21(67.7)	18(54.5)	χ²=1.931	0.381
年龄(岁)	54(44~60)	42(34~61)	38(32~52)	Z=7.574	0.023
FBS(mmol/L)	5.11(4.39~6.12)	5.34(4.79~7.28)	5.29(4.76~6.12)	Z=2.937	0.230
ALT(U/L)	20.23(14.05~32.45)	45.30(24.20~76.51)	46.55(33.65~77.88)	Z=19.181	＜0.001
AST(U/L)	19.20(15.25~25.65)	26.40(20.00~41.30)	29.55(21.58~46.83)	Z=11.969	0.003
TC(mmol/L)	4.07(3.44~4.73)	4.62(3.57~4.97)	5.03(4.27~5.64)	Z=9.097	0.011
TG(mmol/L)	1.32(0.85~2.39)	1.41(1.05~2.12)	2.16(1.25~2.89)	Z=6.333	0.042
HDL(mmol/L)	1.13(0.98~1.35)	1.14(1.00~1.38)	1.23(1.02~1.45)	Z=1.100	0.577
LDL(mmol/L)	2.51±1.00	2.48±0.85	3.10±0.93	F=4.175	0.019
GGT(U/L)	24.30(16.05~47.80)	40.6(30.00~65.70)	42.15(30.05~57.45)	Z=7.667	0.022
sUA(μmmol/L)	349.55±109.80	368.60±100.52	372.28±76.64	F=0.466	0.629
sCr(μmmol/L)	62.44±16.03	68.21±24.99	59.08±14.32	F=1.855	0.162
sUA/Cr	5.72±1.48	5.95±1.86	6.45±1.42	F=1.648	0.199

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表 3 NAFLD发生的影响因素logistic回归分析

因素	OR	95%CI	B值	Wald值	P值
年龄(岁)	1.056	1.005~1.109	0.055	4.735	0.030
HDL(mmol/L)	0.023	0.003~0.186	-3.788	12.423	＜0.001
sUA/Cr	1.885	1.162~3.060	0.634	6.584	0.010

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