非酒精性脂肪性肝病合并高尿酸血症的心血管疾病风险分析

摘要/Abstract

摘要： 目的探讨高尿酸血症对非酒精性脂肪性肝病(nonalcoholic fatty liver disease, NAFLD)心血管疾病风险的影响及其关系。方法依据NAFLD诊断标准,纳入2009年至2015年在广州中山大学附属第一医院消化内科门诊和住院患者,年龄≥18岁,排除其他肝病及酗酒者,采用Framingham危险评分系统及颈动脉超声评估心血管疾病风险。结果共入组678例NAFLD患者,其中尿酸正常者410例,高尿酸血症者268例。行颈动脉超声检查有233例。高尿酸血症(hyperuricemia, HUA)组腰臀比、BMI、收缩压、三酰甘油(TG)、空腹血糖(FBG)、胰岛素抵抗指数(HOMA-IR)、合并代谢综合征比率高于正常尿酸组,高密度脂蛋白(HDL-C)水平低于正常尿酸组(P<0.05)。男性和女性按不同尿酸水平分成4组,Framingham风险评分随尿酸水平升高而升高(P=0.012),但颈动脉内中膜厚度(carotid intima media thickness, CIMT)、颈动脉增厚与颈动脉斑块检出率不同尿酸水平间无明显差异(P值分别为0.691、0.384和0.936)。进一步分析其相关性,Framingham风险及CIMT与尿酸无相关。结论 NAFLD合并高尿酸血症患者代谢紊乱更明显,10年后的心血管疾病风险随尿酸水平的升高而升高。

关键词: 非酒精性脂肪性肝病, 高尿酸血症, 代谢综合征, 心血管疾病

Abstract: Objective To investigate the risk of hyperuricemia on cardiovascular disease in patients with non-alcoholic fatty liver disease (NAFLD).Methods Patients diagnosed of NAFLD in both outpatient and inpatient in our hospital from 2009 to 2015 were enrolled, who were ≥ 18-year old and without the other liver diseases or excessive drinking history. Framingham scoring system and carotid artery ultrasonography were applied for assessing cardiovascular risk.Results A total of 678 NAFLD patients were enrolled, including 410 patients with normal uric acid and 268 patients with hyperuricemia (HUA).Among the 678 NAFLD patients, 233 received carotid artery ultrasonography. Compared to normal uric acid group, HUA group showed higher levels of waist-hip ratio, body mass index (BMI), diastolic blood pressure, triglyceride (TG), fasting plasma glucose (FBG), homeostasis model assessment of insulin resistance (HOMA-IR) and prevalence rate of metabolic syndrome, but lower level of high-density lipoprotein cholesterol (HDL-C) (P<0.05), respectively. Male and female patients were divided into four groups by uric acid level, respectively. Framingham risk showed significantly positive correlation to uric acid level (P=0.012), while no significant differences were observed in carotid intima media thickness (CIMT), incidence of thickening carotid artery and carotid artery plaque among the 4 groups with different uric acid levels (P=0.691, 0.384 and 0.936, respectively). Further analysis revealed that uric acid was not associated with Framingham risk and CIMT.Conclusion Metabolic disorder was more noticeable in NAFLD patients with HUA than that in NAFLD patients with normal uric acid. Ten-year cardiovascular risk exerts a positive correlation with uric acid level.

Key words: Nonalcoholic fatty liver disease, Hyperuricemia, Metabolic syndrome, Cardiovascular disease

李韶丰,叶俊钊,李睿,胡璇,赵文文,钟碧慧. 非酒精性脂肪性肝病合并高尿酸血症的心血管疾病风险分析[J]. 肝脏, 2017, 22(8): 675-679.

LI Shao-feng, YE Jun-zhao, LI Rui, HU Xuan, Zhao Wen-wen, ZHONG Bi-hui. Department of Gastroenterology, The First Affiliated Hospital of Sun Yat Sen University, Guangzhou 510080, China. Cardiovascular risk analysis in nonalcoholic fatty liver disease patients complicated with hyperuricemia[J]. Chinese Hepatolgy, 2017, 22(8): 675-679.

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