肥胖人群血清尿酸水平与非酒精性脂肪性肝病严重程度的相关性分析

Correlation analysis between serum uric acid level and the severity of non-alcoholic fatty liver disease in obese people

目的探究肥胖患者高尿酸血症发生的危险因素以及血清尿酸水平与非酒精性脂肪性肝病(NAFLD)严重程度的相关性。方法回顾性分析2018年7月至2020年9月在南京鼓楼医院减重代谢中心拟行减重代谢手术的247例肥胖患者,收集患者术前临床资料及血清学数据及肝脏NAS评分。结果221例患者进入肥胖患者高尿酸血症的危险因素分析,低尿酸组57(25.8%)人,高尿酸组164(74.2%)人,二组在性别、体质量指数(BMI)、谷丙转氨酶(ALT)、谷草转氨酶(AST)、γ-谷氨酰转肽酶(γ-GT)、总胆红素(TBil)、甘油三酯(TG)、高密度脂蛋白(HDL-C)、低密度脂蛋白(LDL-C)、胰岛素(INS)、C肽(C-peptide)水平存在差异。141例患者拥有完善的病理学结果,其中40例可排除非酒精性脂肪性肝炎(NASH),68例NASH可能,33例可诊断为NASH,三组高尿酸血症发生率分为别78.7%、76.5%、47.5%;多因素logistic回归分析提示三组在小叶内炎症、气球样变、ALT、UA水平存在差异(P<0.05);而进一步研究发现血清尿酸水平与肝脏脂肪变性程度正相关(Spearman分析相关系数r=0.38,P<0.05),而与气球样变及小叶内炎症无明显相关性(血清尿酸与气球样变:Spearman分析相关系数r=0.14,P=0.096;血清尿酸与炎症反应:Spearman分析相关系数r=0.058,P=0.493)。结论随着肥胖患者BMI的增高,发生高尿酸血症以及非酒精性脂肪性肝炎的可能性增高;血清尿酸的增高也会促进肥胖患者非酒精性脂肪性肝病的发展,且血清尿酸水平与肝脏脂肪变性严重程度具有相关性。

Objective To explore the risk factors of hyperuricemia in obese patients and the correlation between serum uric acid levels and the severity of non-alcoholic fatty liver disease at a clinical level.Methods From July 2018 to Sep 2020,a study was conducted retrospectively on 247 obesity patients who underwent bariatric surgery in the Nanjing Drum Tower Hospital.The patient’s general information and serum and the liver NAS activity score were collected before surgery.Results 221 patients were involved in the analysis of risk factors for hyperuricemia,including 57(25.8%)in the hypouric acid group and 164(74.2%)in the hyperuric acid group.The hyperuric acid group had higher BMI,younger age;there are also differences between the levels of ALT,AST,γ-GT,TBil,TG,HDL-C,LDL-C,insulin,and C-peptide.141 patients had complete pathological results,of which 40 cases could exclude NASH,68 cases could be NASH,and 33 cases could be diagnosed as NASH.The incidence of hyperuricemia in different groups was 78.7%,76.5%,47.5%.Multivariate logistic regression analysis suggests that the three groups have differences in intralobular inflammation,ballooning,ALT and UA levels(P<0.05);and the serum uric acid level is positive correlated with the liver steatosis(r=0.38,P<0.05),while no significant correlation with ballooning and intralobular inflammation(ballooning:r=0.14,P=0.096;intralobular inflammation:r=0.058,P=0.493).Conclusions As the increase of BMI in obese patients,the possibility of hyperuricemia and non-alcoholic fatty liver disease increase;young and male patients seem to be easier suffering from hyperuricemia;the increase of serum uric acid also promotes the development of non-alcoholic fatty liver disease in obese patients,and the level of blood uric acid is correlated with the degree of liver steatosis.