男性原发性痛风患者血红蛋白水平与非酒精性脂肪肝的相关性分析  

Relationship between hemoglobin level and nonalcoholic fatty liver disease in male patients with primary gout

作　　者：聂秀玲[1] 宋林凌 苏悦[1] 李明珍[1] 王俊伟[1] 沈丽津[1] 赵伟[1] 孙丽荣[1] Nie Xiuling;Song Linling;Su Yue;Li Mingzhen;Wang Junwei;Shen Lijin;Zhao Wei;Sun Lirong(National Health Commission Key Laboratory of Hormones and Development(Tianjin Medical University),Tianjin Key Laboratory of Metabolic Diseases,Gout Department,Tianjin Institute of Endocrinology,Tianjin Medical University Chu Hsien-I Memorial Hospital,Tianjin 300134,China)

机构地区：[1]国家卫生健康委员会激素与发育重点实验室(天津医科大学),天津市代谢性疾病重点实验室,天津医科大学朱宪彝纪念医院(代谢病医院)内分泌研究所痛风科,300134

出　　处：《中华全科医师杂志》2020年第4期345-348,共4页Chinese Journal of General Practitioners

摘　　要：回顾性分析2014年4月至2018年3月在天津医科大学代谢病医院糖尿病痛风科住院治疗的404例男性痛风患者临床资料,其中121例无脂肪肝、149例合并轻度非酒精性脂肪肝(NAFLD)、134例合并中、重度NAFLD。脂肪肝程度越重者的年龄越小,腹型肥胖越重;外周血红细胞计数、血红蛋白、红细胞压积、红细胞分布宽度的标准差(SD)和变异系数(CV))、甘油三酯、丙氨酸转氨酶、天冬氨酸转氨酶、γ转肽酶、稳态模型估算的胰岛素抵抗指数(HOMA-IR)、血尿酸水平均随着脂肪肝程度的加重而升高;血小板计数、血尿素氮、血清肌酐水平随着脂肪肝程度的加重而下降。logistic回归分析显示体重指数、血红蛋白、HOMA-IR为NAFLD的独立相关因素(OR值分别为0.24、0.30、0.15,均P<0.01)。按血红蛋白水平的四分位计算Q1~Q4者NAFLD患病率分别为12.1%(49/404)、14.9%(60/404)、22.2%(90/404)和20.8%(84/404)(χ^2=25.57,P<0.01);回归分析显示随着血红蛋白水平的升高发生NAFLD的风险明显增加,以Q1者为对照,Q2者的OR值为1.166(95%CI:0.638~2.133),Q3者的OR值2.011(95%CI:1.122~3.605),Q4者的OR值为3.120(95%CI:1.613~6.034),调整年龄因素后,Q4者的OR值为2.567(95%CI:1.359~5.236),均P<0.01。提示男性痛风合并NAFLD患者存在多种代谢紊乱,高血红蛋白血症与NAFLD独立相关。Four hundred and four male patients with primary gout were enrolled.According to the degree of nonalcoholic fatty liver diseases(NAFLD),the patients were divided into simple gout(n=121),gout combined with mild NAFLD(n=149)and gout combined with moderate-severe NAFLD(n=134).The height,weight,waist,hip,blood pressure and blood biochemistry parameters of patients were measured.The degree of NAFLD was negatively correlated with the age of patients in three groups.The BMI,ratio of waist/hip,count of red cells,hemoglobin,hematocrit,red blood cell distribution width(SD and CV),triglyceride,alanine aminotransferase and HOMA-IR were increased with the increasing of NAFLD severity(all P<0.05).Red blood cell count,hemoglobin,alanine aminotransferase,serum uric acid increased with the increasing of NAFLD severity(all P<0.05).Platelet,serum urea nitrogen and serum creatinine were decreased with the increase of NAFLD severity.Logistic regression showed that BMI,hemoglobin and HOMA-IR were independent risk factors for NAFLD.The prevalence and the severity of NAFLD was increased with increasing quadrates of hemoglobin.Taking group Q1 as a control,OR of NAFLD in group Q2 was 1.166(95%CI:0.638-2.133),OR in group Q3 was 2.011(95%CI:1.122-3.605)and OR in group Q4 was 3.120(95%CI:1.613-6.034).The result indicates that hemoglobin levels are associated with the development and the severity of NAFLD in male patients with primary gout.

关 键 词：痛风 男 血红蛋白 非酒精性脂肪肝 胰岛素抵抗 

分 类 号：R589.7[医药卫生—内分泌] R575.5[医药卫生—内科学]