血尿酸与非酒精性脂肪陛肝病发生风险相关性的随访队列研究

Correlation between serum uric acid and risk of new-onset nonalcoholic fatty liver disease： a 5-year observational cohort study

目的通过5年随访队列研究血尿酸与非酒精性脂肪性肝病（NAFLD）发病的相关性。方法采用观察性队列研究，选取2011年在体检中心进行体检的856名未患有NAFLD的体检人群作为研究对象，按照血尿酸基线水平四分位分为4组（F1、F2、F3、F4）。通过5年随访，观察2016年各组NAFLD发病隋况。检测受试者血清丙氨酸氨基转氨酶、天冬氨酸氨基转氨酶、总胆固醇、高密度脂蛋白胆固醇、低密度脂蛋白胆固醇、甘油三酯、空腹血糖等生物化学指标和影像学检查结果。比较各组NAFLD的累积发病率，logistics回归分析基线血尿酸水平对新发NAFLD的影响，受试者工作特征曲线（ROC）分析尿酸水平对NAFLD的诊断价值。结果NAELD累积发病率19．16％，且累积发病率随着基线血尿酸的升高而增加，F1、F2、F3、F4组的发病率分别为7．90％、13．54％、加．32％、34．07％，差异有统计学意义（P〈0．05）。F2、F3、F4组NAFLD发病风险分别为F1组的1．637（0．856～3．344）倍、2．745（1．345～5．211）倍、5．465（2．977～9．843）倍∽〈0．05）。Logistic回归分析显示，随着血尿酸水平的升高，NAFLD发生风险亦随之升高，且血清尿酸水平是NAFLD发病的独立危险因素，RR值为1．654，ROC曲线分析血尿酸水平对NAFLD无诊断价值。结论血清尿酸增高是NAFLD发病的独立危险因素，可作为评估NAFLD发生风险的指标。

Objective To investigate the association between serum uric acid and the risk of newonset nonalcoholic fatty liver disease（NAFLD）. Methods An observational cohort study was conducted in a hospital for five years. 856 patients without NAFLD who took physical examination in the hospital physical examination center in 2011 were selected as study subjects. According to the baseline level of serum uric acid, subjects were divided into 4 groups （F1, F2, F3, and F4）. After 5-years of follow-up, the incidence of NAFLD in each group was observed in 2016.Serum alanine aminotransferase and aspartate aminotransferase, Total cholesterol, High-density lipoprotein cholesterol, Low-density lipoprotein cholesterol, Triglycerides, Fasting blood glucose and Imaging findings were examined. The cumulative incidence rate of NAFLD in each group was compared and the effect of baseline serum uric acid level on new-onset NAFLD was analyzed by Logistic regression. The receiver operating characteristic curve （ROC） was used to analyze the diagnostic value of uric acid level in NAFLD. Results The cumulative incidence rate of NAFLD was 19.16%, and the cumulative incidence increased with the increase of baseline uric acid. The incidence rates of F 1, F2, F3 and F4 were 7.90%, 13.54%, 20.32% and 34.07% respectively. The difference was statistically significant （P 〈 0.05）. The incidence rate of NAFLD in F2, F3 and F4 groups were 1.637 （0.856 - 3.344） times, 2.745 （1.345 - 5.211） times and 5.465 （2.977 - 9.843） times higher than those in F1 group （P 〈 0.05）. The logistic regression analysis showed that the risk of NAFLD increased with the increase of serum uric acid level, and the serum uric acid level was an independent risk factor for NAFLD with a relative risks （RR） value of 1.654. The ROC curve analysis of serum uric acid levels had no diagnostic value for NAFLD. Conclusion Our study demonstrates that increased serum uric acid level is an independent risk factor for the development of NAFLD and could be used as an investigative indicator to assess the risk.