内脏脂肪面积与尿酸结石形成的相关性研究  

The relationship between visceral fat area and uric acid stone formation

作　　者：徐宏博[1] 魏雪栋[1] 胡林昆[1] 牛健[2] 袁和兴[1] 黄玉华[1] 何军[2] 侯建全[1] Xu Hongbo;Wei Xuedong;Hu Linkun;Niu Jian;Yuan Hexing;Huang Yuhua;He Jun;Hou Jianquan(Department of Urology,The First Affiliated Hospital of Soochow University,Suzhou 215006,China;Center for Clinical Laboratory,The First Affiliated Hospital of Soochow University,Suzhou 215006,China)

机构地区：[1]苏州大学附属第一医院泌尿外科,215006 [2]苏州大学附属第一医院临床检测中心,215006

出　　处：《中华泌尿外科杂志》2019年第2期105-110,共6页Chinese Journal of Urology

摘　　要：目的 探讨腹部CT测定的内脏脂肪面积(VFA)与尿酸结石形成的相关性。 方法 回顾性分析2017年1月至2018年1月我院收治的247例泌尿系结石患者的临床资料。男161例,女86例;年龄(51.0±13.3)岁(20~88岁)。根据术后结石成分分析结果,将患者分为尿酸结石组和非尿酸结石组。基于腹部CT图像,采用Image J软件测定腰围、腹部脂肪总面积(TFA)、VFA、皮下脂肪面积(SFA)等人体测量指标。观察两组患者临床指标间的差异,并进行单因素及多因素logistic回归分析。应用受试者工作特征(ROC)曲线确定VFA的最佳临界值,并通过曲线下面积(AUC)比较不同人体测量指标对尿酸结石形成的预测价值。 结果 247例中尿酸结石组35例(14.2%),非尿酸结石组212例(85.8%)。根据ROC曲线确定VFA的最佳临界值为130 cm^2,高VFA者(≥130 cm^2)的尿酸结石比例[25.5% (28/110)]明显高于低VFA者(<130 cm^2)[5.1%(7/137)],差异有统计学意义(P<0.05)。尿酸结石组和非尿酸结石组患者的年龄[(55.1±13.5)岁与(50.3±13.2)岁]、糖尿病比例[22.9%(8/35)与8.5%(18/212)]、高脂血症比例[45.7%(16/35)与19.3%(41/212)]、TFA[313.4(264.1,435.2) cm^2与285.3(212.2,352.5) cm^2]、腰围[(90.5±8.3)cm与(84.8±9.1)cm]、体重指数[(25.8±3.2) kg/m^2与(24.2±3.2) kg/m^2]、VFA[157.6(130.7,205.0) cm^2与117.9(82.4,159.5) cm^2]、血尿酸[417.0(362.0,477.0) μmol/L与332.0(283.0,388.8) μmol/L]、尿pH值[5.5(5.0,5.5)与6.0(5.5,6.5)]差异均有统计学意义(P<0.05)。多因素logistic回归分析结果显示,糖尿病(OR=3.408, 95%CI 1.123~10.340,P=0.030)、VFA(OR=6.740,95%CI 1.951~23.279,P=0.003)、血尿酸(OR=3.182,95%CI 1.120~9.040,P=0.030)、尿pH值(OR=4.052,95%CI 1.095~14.989,P=0.036)为尿酸结石形成的独立影响因素。ROC曲线显示TFA、腰围、体重指数、VFA、SFA的AUC分别为0.659、0.665、0.632、0.723、0.544。 结论 糖尿病、VFA、血尿酸、尿pH值是尿酸结石形成的独立影响因素。相较于TFA、腰围、�Objective To investigate the relationship between uric acid stone formation and visceral fat area based on computed tomography.Methods As many as 247 patients admitted to our hospital were retrospectively reviewed from January 2017 to January 2018. There were 161 males (65.2%) and 86 females (34.8%). The average age was 51 (20-88 years). According to the results of stone analysis after surgery, the patients were divided into uric acid stone group and non-uric acid stone group. According to the abdominal CT scan, Image J software was used to measure the anthropometric measurements like waist circumference, total fat area (TFA), and visceral fat area (VFA), and subcutaneous fat area (SFA). The clinical characteristics of different stone components were compared. An univariate and multivariate logistic regression analysis was used to identify the independent factors associated with uric acid stone formation. Different anthropometric measurements were compared by using the area under receiver operating characteristic curve.Results The uric acid stones in high VFA group (28/110;25.5%) were obviously more frequent than that in the low VFA group (7/137;5.1%) (P<0.05). The results of the univariate logistic regression analysis showed that age, diabetes, hyperlipidemia, TFA, waist circumference, body mass index (BMI), VFA, uric acid, and urine pH were statistically significant (P<0.05). Multivariate logistic regression analysis revealed that diabetes (OR=3.408, 95%CI 1.123-10.340, P=0.030), VFA (OR=6.740, 95%CI 1.951-23.279, P=0.003), uric acid (OR=3.182, 95%CI 1.120-9.040, P=0.030) and urine pH (OR=4.052, 95%CI 1.095-14.989, P=0.036) were independent factors associated with uric acid stone formation. The area under the curve of TFA, waist circumference, BMI, VFA, and SFA were 0.659, 0.665, 0.632, 0.723 and 0.544, respectively. Conclusions Diabetes, VFA, uric acid and urine pH are independent factors influencing the formation of uric acid stones. Compared with other anthropometric measurements such as TFA, waist circumfer

关 键 词：内脏脂肪面积 尿酸结石 代谢综合征 腹型肥胖 

分 类 号：R691.4[医药卫生—泌尿科学]