血尿酸联合高密度脂蛋白胆固醇对健康体检人群非酒精性脂肪性肝病的诊断价值

Diagnostic value of serum uric acid combined with high-density lipoprotein cholesterol for nonalcoholic fatty liver disease in health examination population

目的评估血尿酸联合高密度脂蛋白胆固醇(HDL-C)对健康体检人群非酒精性脂肪性肝病(NAFLD)的诊断价值。方法一项横断面研究。回顾性选取2022年1至11月浙江大学医学院附属第一医院健康管理中心接受健康体检的3903例受检者纳入研究。对受检者完成人口学、人体学检查、实验室检测以及肝脏瞬时弹性成像检测。通过t检验、单因素方差分析、Wilcoxon秩和检验对比有无NAFLD情况下的各项指标,分析不同程度脂肪肝下血清尿酸、HDL-C表达水平;应用受试者工作特征曲线及曲线下面积(AUC)考察血尿酸联合HDL-C对NAFLD的诊断价值。结果NAFLD组患者体重指数、尿酸、丙氨酸氨基转移酶等指标均高于非NAFLD组,HDL-C低于非NAFLD组(均P<0.001)。正常肝脏组血尿酸(303.62±77.65)μmol/L<轻度脂肪肝组(336.82±82.43)μmol/L<中度脂肪肝组(364.25±79.62)μmol/L<重度脂肪肝组(392.98±83.90)μmol/L(F=202.614,P<0.001);正常肝脏组HLD-C(1.43±0.37)mmol/L>轻度脂肪肝组(1.25±0.31)mmol/L>中度脂肪肝组(1.16±0.28)mmol/L>重度脂肪肝组(1.04±0.25)mmol/L(F=239.24,P<0.001)。NAFLD在高尿酸血症组(HUA组)(75.0%)、低HDL-C血症组(76.3%)、HUA+低HDL-C组中(86.9%)的占比均明显高于尿酸及HDL-C正常组(49.2%),且HUA+低HDL-C组的NAFLD占比最高(χ^(2)=302.109,P<0.001)。尿酸、HDL-C二者联合(AUC=0.741)较单独尿酸、HDL-C(AUC=0.692、0.288)对NAFLD有更高的诊断价值(P<0.001)。结论血清尿酸、HDL-C与NAFLD严重程度相关,尿酸联合HDL-C对NAFLD具有一定的诊断价值。

Objective To assess the value of serum uric acid combined with high-density lipoprotein cholesterol(HDL-C)for the diagnosis of nonalcoholic fatty liver disease(NAFLD)in health examination population.Methods A cross-sectional study was conducted.Total of 3903 subjects who underwent health examination in the health management center of the First Affiliated Hospital of Zhejiang University School of Medicine from January to November 2022 were retrospectively selected for this study.The demography and somatology examination,laboratory tests and transient elastography of the liver were carried out in all the subjects.The indices were compared in people with and without NAFLD with t test,single factor analysis of variance or Wilcoxon rank sum test.And the levels of uric acid and HDL-C under different degrees of fatty liver were analyzed.The diagnostic value of uric acid combined with HDL-C for NAFLD was examined with the receiver operator characteristic(ROC)curve and area under the ROC curve(AUC).Results Body mass index,uric acid and glutathione transaminase in the NAFLD group were all higher than those in the non-NAFLD group,and HDL-C was lower(all P<0.001).Blood uric acid in normal liver group(303.62±77.65)μmol/L<mild fatty liver group(336.82±82.43)μmol/L<moderate fatty liver group(364.25±79.62)μmol/L<severe fatty liver group(392.98±83.90)μmol/L(F=202.614,P<0.001);HLD-C in normal liver group(1.43±0.37)mmol/L>mild fatty liver group(1.25±0.31)mmol/L>moderate fatty liver group(1.16±0.28)mmol/L>severe fatty liver group(1.04±0.25)mmol/L(F=239.24,P<0.001).The proportion of NAFLD in hyperuricemia group(HUA group)(75.0%),low HDL-C group(76.3%),and HUA and low HDL-C group(86.9%)was significantly higher than that in normal uric acid and HDL-C groups(49.2%),and the proportion of NAFLD in HUA and low HDL-C group was the highest(χ^(2)=302.109,P<0.001).The diagnostic value of the combination of serum uric acid and HDL-C for NAFLD is higher than that of serum uric acid or HDL-C alone(the AUC was 0.741,0.692 and 0.288,respectively)(both P<0.001).Conclusion Serumuric acid and HDL-C were correlated with the severity of NAFLD,and uric acid combined with HDL-C had some diagnostic value for NAFLD.