非酒精性脂肪性肝病与白蛋白尿的相关性

Relationship between non-alcoholic fatty liver disease and albuminuria

目的探讨非酒精性脂肪性肝病(NAFLD)与白蛋白尿的相关性。方法对2016年2-10月在福建医科大学附属第一医院老年医学科门诊及住院患者进行横断面研究。根据B超结果将患者分为无NAFLD组、轻度NAFLD组和中重度NAFLD组。留取晨尿测量尿白蛋白和尿肌酐,将尿白蛋白/肌酐(UACR)≥30 mg/g定义为白蛋白尿,<30 mg/g定义为正常蛋白尿。比较白蛋白尿患者与正常蛋白尿患者中不同程度的NAFLD比例的差别,应用二元logistic回归分析白蛋白尿发生的独立相关因素,并进行老年、糖尿病和高血压患者的亚组分析。结果共纳入511名研究对象,平均年龄(60.9±12.0)岁,中重度脂肪肝患者中UACR[9.9(5.2~25.2)比6.4(4.2~11.7)、5.6(4.0~10.2)mg/g,P<0.05]和白蛋白尿的检出率(23.1%比8.5%、7.5%,P<0.05)高于无NAFLD和轻度NAFLD患者。白蛋白尿患者的中重度NAFLD比例高于正常蛋白尿受检者(62.3%比32.4%,P<0.05)。Logistic回归分析显示,中重度NAFLD与白蛋白尿独立相关(OR=2.762,95%CI 1.418~5.382,P<0.05)。亚组分析显示,在非老年人,非糖尿病以及高血压和非高血压受检者中,中重度NAFLD与白蛋白尿独立相关,而在老年糖尿病患者中,中重度NAFLD与白蛋白尿无独立相关。结论中重度NAFLD与白蛋白尿独立相关,在非老年人和非糖尿病人群中尤为明显。

Objective To investigate the relationship between non-alcoholic fatty liver disease(NAFLD)and albuminuria.Methods A cross-sectional study was conducted in the First Affiliated Hospital of Fujian Medical University from February to October 2016.Clinic or hospitalized patients were enrolled in this study and divided into non-NAFLD group,mild NAFLD group and moderate to severe NAFLD group according to ultrasonographic findings.Morning urine of all patients was collected to measure urinary albuminuria and creatinine.Albuminuria and normal albuminuria were defined as urinary albumin/creatinine(UACR)≥30 mg/g and<30 mg/g,respectively.The incidence of NAFLD in different severity classes was compared between patients with and without albuminuria.Logistic regression was use to identify the independent contributing factors of albuminuria,and subgroup analysis was conducted targeting the elderly,hypertensive and diabetic patients.Results A total of 511 subjects were enrolled,with an average age of(60.9±12.0)years.The level of UACR[median(interquartile range):9.9(5.2-25.2)vs 6.4(4.2-11.7)and 5.6(4.0-10.2)mg/g,P<0.05]and the incidence of albuminuria(23.1%vs 8.5%and 7.5%,P<0.05)in patients with moderate to severe NAFLD were significantly higher than those without NAFLD or with mild NAFLD.And the incidence of moderate to severe NAFLD in patients with albuminuria was higher than those with normal albuminuria(62.3%vs 32.4%,P<0.05).Logistic regression analysis showed that moderate to severe NAFLD was independently associated with albuminuria(odds ratio,95%confidence interval:2.762,1.418-5.382,P<0.05).Subgroup analysis revealed that moderate to severe NAFLD was independently associated with albuminuria in non-elderly,non-diabetic,hypertensive and non-hypertensive subjects,but not in elderly and diabetic patients.Conclusion Moderate to severe NAFLD is independently associated with albuminuria,especially in non-elderly and non-diabetic subjects.