血尿酸与非酒精性脂肪性肝病发生风险相关性四年随访观察研究

Four-year follow-up observation on the relationship between serum uric acid and the risk of nonalcoholic fatty liver disease

目的分析血尿酸与非酒精性脂肪性肝病（nonalcoholic fatty liver disease，NAFLD）发病的相关性。方法采用观察性队列研究，选取2009年在北京医院体检中心进行体检的未患NAFLD，年龄30~60岁的732人作为研究对象，按照血尿酸水平四分位分为4组（Q1，Q2，Q3，Q4）。经过4年随访，观察2013年各组NAFLD发病情况。检测研究对象的血清丙氨酸氨基转移酶、天冬氨酸氨基转氨酶、三酰甘油、总胆固醇、高密度脂蛋白胆固醇、低密度脂蛋白胆固醇、空腹血糖等相关生化指标和影像学检查结果。比较各组NAFLD的累积发病率，用Logistic回归分析基线血尿酸水平对新发NAFLD的影响。结果NAFLD的累积发病率随着基线血尿酸的增加而增加（分别为8.70%，13.04%，19.23%，32.97%），差异有统计学意义（χ^2=37.865，P〈0.05）。Logistic回归分析显示，随着尿酸水平的增高，发生NAFLD的风险也随之增高。Q2组、Q3组、Q4组NAFLD发病风险分别为Q1组的1.575（0.807~3.074）倍，2.580（1.329~4.701）倍，5.164（2.838~9.397）倍（P均〈0.05）。多元Logistic回归分析显示血尿酸是NAFLD发病的独立危险因素，比值比为1.234。结论血尿酸高是NAFLD发病的独立危险因素，可作为评估患者NAFLD发生风险的指标。

Objective To investigate the relationship between serum uric acid and the risk of nonalcoholic fatty liver disease.Methods A cohort study was performed among individuals who had physical examination at Beijing Hospital medical examination center during 2009. A total of 732 subjects without nonalcoholic fatty liver disease, 30-60 years old, were selected. Subjects were divided into 4 groups （Q1, Q2, Q3, Q4） according to serum uric acid level. The incidence of NAFLD in each group in 2013 were observed. Serum alanine aminotransferase, aspartate aminotransferase, triglycerides, total cholesterol, high density lipoprotein-cholesterol, low density lipoprotein-cholesterol, fasting plasma glucose, and imaging examinations were determined. Cumulative incidence of NAFLD was compared between each group and effect of baseline serum uric acid on new-onset NAFLD was assessed by logistic regression analysis.Results The cumulative incidence of NAFLD increased in conjunction with the increase of baseline serum uric acid in 4 groups （Q1 8.70%, Q2 13.04%, Q3 19.23%, Q4 32.97%, χ^2=37.865, P〈0.05）. Logistic regression showed that the incidence of nonalcoholic fatty liver disease was increased along with elevated levels of serum uric acid. Subjects in the Q2, Q3, Q4 groups showed an increased risk of NAFLD, relative risks were 1.575 （0.807-3.074）; 2.580 （1.329-4.701）; 5.164 （2.838-9.397）, compared to those in Q1 group. Moreover, after adjustment for baseline factors （e.g. Age, sex）, risk of NAFLD remained higher, with odds ratio at 1.234, and the difference was statistically significant.Conclusions Serum uric acid was found to be correlated with the prevalence of nonalcoholic fatty liver disease. Serum uric acid appeared to be an independent risk factor for NAFLD.