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摘要：
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摘要：目的 探讨血清尿酸对非酒精性脂肪性肝病（non-alcoholic fatty liver disease，NAFLD）进展期
肝纤维化/肝硬化的诊断价值。方法 选取2012年1月至2014年1月于中国人民武装警察部队特色医学中
心治疗的140例NAFLD患者进行横断面研究。综合临床表现和病理结果将患者分为非进展期肝纤维
化组（89例）和进展期肝纤维化/肝硬化组（51例）。比较两组患者性别、年龄、体质量指数（body
mass index，BMI）、腰臀比、烟酒史、合并症；丙氨酸氨基转移酶（alanine aminotransferase，
ALT）、天门冬氨酸氨基转移酶（aspartate aminotransferase，AST）、白蛋白（albumin，ALB）、总
胆红素（total bilirubin，TBil）、碱性磷酸酶（alkaline phosphatase，ALP）、甘油三酯（triglyceride，
TG）、总胆固醇（total cholesterol，TC）、高密度脂蛋白胆固醇（high-density lipoprotein
cholesterol，HDL-C）、尿素氮（urea nitrogen，BUN）、肌酐（creatinine，Cr）、尿酸（uric acid，
UA）、空腹血糖（fasting blood glucose，FBG）、空腹胰岛素（fasting insulin，FINS）、HOMA-IR指
数及血小板计数（platelet，PLT），行FibroScan记录受控衰减参数（controlled attenuation parameter，
CAP）和肝硬度（liver stiffness measurement，LSM）值。采用Logistic多因素回归分析NAFLD患者进
展期肝纤维化/肝硬化的独立危险因素。采用受试者工作特征（receiver operator characteristic，ROC）
曲线评估独立危险因素诊断进展期肝纤维化/肝硬化的价值。结果 进展期肝纤维化/肝硬化组与非进
展期肝纤维化组患者年龄[（56.93 ± 10.46）岁vs（41.72 ± 13.85）岁]、BMI [（31.15 ± 2.58）kg/m 2 vs
（28.24 ± 2.93）kg/m 2 ]、腰臀比（中位数：0.93 vs 0.90）、糖尿病比例（47.06% vs 21.35%）、PLT
（中位数：202.96 × 10 9 /L vs 242.33 × 10 9 /L）、AST [（62.41 ± 30.58）U/L vs（47.81 ± 29.06）U/L]、
TBil（中位数：22.38 μmol/L vs 15.05 μmol/L）、FBG（中位数：6.91 mmol/L vs 6.48 mmol/L）、FNIS
[（19.05 ± 10.21）μU/ml vs（14.58 ± 6.84）μU/ml]、HOMA-IR指数（中位数：5.11 vs 4.13）、UA（中
位数：399.61μmol/L vs 348.86 μmol/L]、CAP [（342.74 ± 56.26）dB/m vs（323.58 ± 64.47）dB/m]、
LSM值（中位数：12.00 kPa vs 7.40 kPa）的差异有统计学意义（P均＜ 0.05）。多因素分析显示高腰
臀比、高HOMA-IR、高FBG、高FNIS、高UA、高LSM是NAFLD进展期肝纤维化/肝硬化的发病独立
危险因素（P ＜ 0.05）。ROC曲线表明，腰臀比、HOMA-IR、FBG、FNIS、UA及LSM可提示进展期
肝纤维化/肝硬化的发生，UA的ROC曲线下面积为0.736。结论 血清尿酸对诊断NAFLD进展期肝纤维
化/肝硬化具有一定价值。
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Abstract: Objective To investigate the diagnostic value of serum uric acid (UA) on advanced fibrosis and
cirrhosis in non-alcoholic fatty liver disease (NAFLD). Methods A total of 140 patients with NAFLD in
Characteristic Medical Center of the Chinese People’s Armed Police Force from January 2012 to January
2014 were enrolled in this cross-sectional study. According to the clinical comprehensive performance and
pathological results, the patients were divided into non-advanced fibrosis group (89 cases) and advanced
fibrosis/liver cirrhosis group (51 cases), the gender, age, body mass index (BMI), waist-to-hip ratio, history
of tobacco and alcohol, comorbidities; alanine aminotransferase (ALT), aspartate aminotransferase (AST),
albumin (ALB), total bilirubin (TBil), alkaline phosphatase (ALP), triglyceride (TG), total cholesterol (TC),
high-density lipoprotein cholesterol (HDL-C), urea nitrogen (BUN), creatinine (Cr), uric acid (UA), fasting
blood glucose (FBG), fasting insulin (FINS), HOMA-IR index; platelet count (PLT) of patients in two group
were compared. Logistic multivariate regression analysis was used to analyzed the independent risk factors for
NAFLD advanced liver fibrosis/cirrhosis. The area under the receiver operating characterstic (ROC) curve was
used to evaluate the diagnostic value of meaningful indicators. Results Age [(56.93 ± 10.46) years vs (41.72 ±
13.85) years], BMI [(31.15 ± 2.58) kg/m 2 vs (28.24 ± 2.93) kg/m 2 ], waist-to-hip ratio (median: 0.93 vs 0.90),
proportion of diabetes (47.06% vs 21.35%), PLT (median: 202.96 × 10 9 /L vs 242.33 × 10 9 /L), AST [(62.41 ±
30.58) U/L vs (47.81 ± 29.06) U/L], TBil (median:22.38 μmol/L vs 15.05 μmol/L), FBG (median: 6.91 mmol/L vs
6.48 mmol/L], FNIS [(19.05 ± 10.21) μU/ml vs (14.58 ± 6.84) μU/ml], HOMA-IR index (median: 5.11 vs 4.13), UA
(median: 399.61 μmol/L vs 348.86 μmol/L), CAP [(342.74 ± 56.26) dB/m vs (323.58 ± 64.47) dB/m] and LSM (median:
12.00 kPa vs 7.40 kPa) of patients in advanced fibrosis/liver cirrhosis group and non-advanced fibrosis group
were statistically significant (all P ＜ 0.05). Multivariate analysis showed that high waist-to-hip ratio, high
HOMA-IR, high FBG, high FNIS, high UA, and high LSM had significant effects on the onset of advanced
fibrosis and cirrhosis in patients with NAFLD (P ＜ 0.05). The ROC curve showed that the waist-to-hip ratio,
HOMA-IR, FBG, FNIS, UA and LSM can diagnose the occurrence of advanced fibrosis and cirrhosis, the
AUC of UA was 0.736. Conclusions Serum uric acid has certain value in the diagnosis of advanced fibrosis
and liver cirrhosis in NAFLD.
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