血尿酸在慢性乙型肝炎合并非酒精性脂肪性肝病中的临床意义  

Clinical significance of serum uric acid in patients with chronic hepatitis B complicated with non-alcoholic fatty liver disease

作　　者：黄春明[1] 聂玉强[2] 胡中伟[1] 杨湛[1] 周永健[2] 詹远京[1] 郭家伟[1] 余卫华[1] 欧志涛[1] HUANG Chunming;NIE Yuqiang;HU Zhongwei;YANG Zhan;ZHOU Yongjian;ZHAN Yuanjing;GUO Jiawei;YU Weihua;OU Zhitao(Department of Gastroenterology,Guangzhou Eighth People＇s Hospital,Guangzhou 510060;Department of Gastroenterology,Guangzhou First People＇s Hospital,China)

机构地区：[1]广州市第八人民医院消化内科,广东广州510060 [2]广州市第一人民医院消化内科

出　　处：《胃肠病学和肝病学杂志》2018年第10期1125-1130,共6页Chinese Journal of Gastroenterology and Hepatology

基　　金：广州市卫生局项目(2014KP000027)

摘　　要：目的探讨血尿酸在慢性乙型肝炎(chronic hepatitis B,CHB)合并非酒精性脂肪性肝病(non-alcoholic fatty liver disease,NAFLD)中的作用与临床价值。方法回顾性分析我院2010年1月1日至2015年12月31日通过肝组织活检诊断为CHB住院患者492例,根据是否合并NAFLD分为NAFLD组和非NAFLD组。Metavir评分系统进行组织学活动度(A)和纤维化分期(F)评分,ROC曲线评估血尿酸是否可以预测肝细胞脂肪变。结果以肝组织病理活检作为金标准,非NAFLD组319例,NAFLD组173例。NAFLD组高尿酸血症是非NAFLD组的2. 614倍。在NAFLD组中,血尿酸与肝纤维化呈负相关,与肝细胞脂肪变分级呈正相关,但与肝脏组织学活动度无关;χ2检验提示血尿酸正常组肝纤维化F2～F4是高尿酸血症组2. 415倍(95%CI:1. 180～4. 942),高尿酸血症组肝细胞脂肪变2～3级是血尿酸正常组4. 673倍(95%CI:1. 375～15. 882),差异有统计学意义(P <0. 05)。非NAFLD组,血尿酸与肝脏组织学活动度、纤维化分期均无关。肝细胞脂肪变与肝组织学活动度呈负相关(r=-0. 111,P=0. 013),但与纤维化分期不相关(r=-0. 035,P=0. 441)。血尿酸预测CHB合并肝细胞脂肪变ROC曲线下面积是0. 630(95%CI:0. 577～0. 683),约登指数0. 201,cut-off值376. 9μmol/L,灵敏度53. 7%,特异度66. 4%。结论高尿酸血症是CHB发生肝细胞脂肪变的危险因素;血尿酸与CHB合并NAFLD的肝纤维化、肝细胞脂肪变相关,与组织学活动度无关;同时血尿酸与CHB组织学活动度及纤维化无关。血尿酸对于肝细胞脂肪变具有一些预测价值,但灵敏度和特异度不高。Objective To investigate the role and clinical value of serum uric acid in patients with chronic hepatitis B （CHB） complicated with non-alcoholic fatty liver disease （NAFLD）.Methods Four hundred and ninety-two cases of CHB hospitalized patients diagnosed by liver biopsy from Jan.1, 2010 to Dec.31, 2015 in our hospital were analyzed retrospectively. They were divided into NAFLD group and non-NAFLD group according to whether complicated with NAFLD. According to Metavir scoring system, scores of histologic activity （A） and fibrosis staging （F） were calculated. The biochemical indexes between two groups were compared. ROC curve was used to assess whether serum uric acid could predict hepatic steatosis.Results Liver biopsy as the gold standard, non-NAFLD group were 319 cases, while NAFLD group were 173 cases. Hyperuricemia in NAFLD group was 2.614 times as high as that in non-NAFLD group. In NAFLD group, serum uric acid was negatively correlated with liver fibrosis, and positively correlated with hepatic steatosis grading, but not correlated with histologic activity. The Chi square test showed that F2-F4 in hyperuricemia group was 2.415 times higher than that in hyperuricemia group （95% CI 1.180-4.942）, while the hepatic steatosis 2-3 in hyperuricemia group was 4.673 times higher than that in normal serum uric acid group （95% CI ： 1.375 - 15.882 ）, and the difference was statistically significant （ P 〈0.05）. In non-NAFLD group, serum uric acid had no relationship with histologic activity and fibrosis stage. Hepatic steatosis was negatively correlated with histologic activity （ r= -0.111 , P =0.013）, but not correlated with liver fibrosis （ r=-0.035, P =0.441）. The area under the ROC curve of CHB with hepatic steatosis was 0.630 （95% CI ： 0.577-0.683）, Youden index was 0.201, the cut-off value was 376.9 μmol/L, the sensitivity and specificity were 53.7% and 66.4%.Conclusion Serum uric acid is a risk factor for hepatic steatosis in patients with CHB; serum uric acid is ass

关 键 词：血尿酸 慢性乙型肝炎 非酒精性脂肪性肝病 纤维化分期 组织学活动度 

分 类 号：R575.5[医药卫生—消化系统] R512.62[医药卫生—内科学]