血清尿酸肌酐比值与非肥胖型代谢相关脂肪性肝病的相关性分析  

Association between serum uric acid-to-creatinine ratio and metabolic associated fatty liver disease in non-obese patients

作　　者：葛宇 王超群 陈怡 沈若宇 董旭 GE Yu;WANG Chao-qun;CHEN Yi;SHEN Ruo-yu;DONG Xu(Department of Ultrasound Medicine,The First Affiliated Hospital of Naval Military Medical University,Shanghai 200433,China;Department of Endocrinology,The First Affiliated Hospital of Naval Military Medical University,Shanghai 200433,China;Department of Infectious Diseases,The First Affiliated Hospital of Naval Military Medical University,Shanghai 200433,China)

机构地区：[1]海军军医大学第一附属医院超声医学科,上海200433 [2]海军军医大学第一附属医院内分泌科,上海200433 [3]海军军医大学第一附属医院感染科,上海200433

出　　处：《肝脏》2024年第8期985-989,共5页Chinese Hepatology

基　　金：上海市青年科技英才扬帆计划项目(21YF1458800);军队护理创新与培育专项计划(2021HL029)。

摘　　要：目的探索血清尿酸/肌酐(UA/Cr)比值与非肥胖型代谢相关脂肪性肝病(MAFLD)的相关性。方法以2023年7月至12月在海军军医大学第一附属医院健康管理中心进行年度体检的人员为研究对象,分为非肥胖型MAFLD患者(n=669)、肥胖型MAFLD患者(n=1594)、非肥胖型健康对照者(n=116)。比较3组的一般情况、基线肝肾功能、血糖、血脂、UA/Cr水平。采用二元logistic回归分析非肥胖型MAFLD的危险因素,ROC曲线分析UA/Cr、BMI、ALT、TG对非肥胖型MAFLD的预测效能,相关性分析采用Spearman检验。结果8764名体检者中,MAFLD患者2350例(26.8%),其中非肥胖型669例,占全部MAFLD患者的29.6%。相较于116名非肥胖型健康对照者,非肥胖型MAFLD患者的年龄大、男性占比高,ALT、AST、γ-GT、AKP、FBG、TG、TC、LDL-C、UA[345.0(289.0,399.0)比262.0(230.3,306.5)μmol/L]、Cr[73.0(61.0,83.3)比60.0(53.0,68.0)μmol/L]、UA/Cr[4.8(4.1,5.5)比4.3(3.9,4.9)]高,HDL-C低,差异有统计学意义(P<0.05)。二元logistics回归分析提示大龄、男性、BMI、ALT、TG是非肥胖型人群中MAFLD患病的独立危险因素。ROC曲线结果显示,UA/Cr(AUC=0.6399,95%CI:0.5821~0.6857)、BMI(AUC=0.8198,95%CI:0.7715~0.8681)、ALT(AUC=0.7868,95%CI:0.7408~0.8328)、TG(AUC=0.8208,95%CI:0.7802~0.8613)均可用于预测非肥胖人群中MAFLD的发生。UA/Cr与BMI(r=0.05,P<0.01)、ALT(r=0.04,P<0.01)和TG(r=0.02,P<0.01)水平无相关性。以UA/Cr的最佳截断值4.365为界,将非肥胖人群分为低、高UA/Cr组,两组MAFLD发生率分别78.0%和89.5%,差异有统计学意义(χ^(2)=19.120,P<0.01)。结论UA/Cr与非肥胖型MAFLD的发生相关,可以用于预测非肥胖型MAFLD的发生。Objective To investigate the correlation between the serum uric acid/creatinine(sUA/Cr)ratio and metabolic-associated fatty liver disease(MAFLD)in non-obese patients.Methods A retrospective analysis was conducted on individuals who underwent annual physical examinations at the Health Management Center of the First Affiliated Hospital of the Naval Medical University from July to December 2023.The study subjects were divided into three groups:non-obese MAFLD patients(n=669),obese MAFLD patients(n=1594),and non-obese healthy controls(n=116).Ggeneral conditions,baseline liver and kidney functions,blood glucose levels,and lipid profiles,and sUA/Cr levels were compared between the groups.Binary logistic regression was employed to analyze the risk factors for non-obese MAFLD,while ROC curves were used to evaluate the predictive efficacy of sUA/Cr,BMI,ALT,and TG for non-obese MAFLD.Spearman’s test was utilized for correlation analysis.Results Among 8764 individuals undergoing physical examinations,26.8% were diagnosed with MAFLD,with the non-obese type accounting for 29.6% of all MAFLD cases.Compared to non-obese healthy controls,non-obese MAFLD patients were older,had a higher proportion of males,and sxhibited elevated levels of ALT,AST,γ-GT,AKP,FBG,TG,TC,LDL-C,sUA[345.0(289.0,399.0)vs.262.0(230.3,306.5)μmol/L],Cr[73.0(61.0,83.3)vs.60.0(53.0,68.0)μmol/L],and sUA/Cr ratio[4.8(4.1,5.5)vs.4.3(3.9,4.9)],while HDL-C was lower.These differences were statistically significant(P<0.05).Binary logistic regression analysis indicated that older age,male gender,BMI,ALT,and TG were independent risk factors for MAFLD in the non-obese population(P<0.05),while sUA/Cr was not an independent risk factor(P>0.05).ROC curves analysis demonstrated that sUA/Cr(AUC=0.6399,95%CI 0.5821-0.6857),BMI(AUC=0.8198,95%CI 0.7715-0.8681),ALT(AUC=0.7868,95%CI 0.7408-0.8328),and TG(AUC=0.8208,95%CI 0.7802-0.8613)could predict MAFLD occurrence in non-obese individuals sUA/Cr was not correlated with BMI(r=0.05,P<0.01),ALT(r=0.04,P<0.01)or TG(r=0.02,P<0.

关 键 词：尿酸 肌酐 代谢相关脂肪性肝病 非肥胖型 

分 类 号：R575.5[医药卫生—消化系统]