痛风患者血红蛋白水平与非酒精性脂肪性肝病关系的研究

目的:探讨痛风合并非酒精性脂肪性肝病（NAFLD）患者血红蛋白的特征以及血红蛋白水平与NAFLD的关系。 方法:选取住院痛风患者537例，行腹部超声检查,根据NAFLD程度（无、轻、中重度）分为单纯痛风组、痛风合并轻度 脂肪肝、痛风合并中重度脂肪肝3组。以血红蛋白水平四分位分组，Q1组（血红蛋白<135 g/L）、Q2组（135 g/L≤血 红蛋白＜145 g/Ｌ）、Q3组（145 g/L≤血红蛋白＜154 g/L)、Q4组（血红蛋白≥154 g/L）。测量身高、体重、腰围 、臀围、血压。抽取肘静脉血测血常规、总胆固醇、甘油三酯、高密度脂蛋白-胆固醇、低密度脂蛋白-胆固醇、肝酶 、尿素氮、肌酐、尿酸、糖化血红蛋白、血糖、胰岛素，计算稳态模型评估-胰岛素抵抗指数（HOMA-IR）。结果:3组 间一般资料比较显示，脂肪肝程度越重组年龄越小，体重指数、腰臀比越大；红细胞计数、血红蛋白、红细胞压积、 红细胞分布宽度标准差（SD）、红细胞分布宽度变异系数（CV）、甘油三酯、谷丙转氨酶、谷草转氨酶、γ转肽酶、 空腹血糖、糖化血红蛋白、血尿酸、HOMA-IR均随着脂肪肝程度的加重而明显升高 （F=3.08～34.85，均P<0.05）。病 程、累及关节数、血小板、血尿素氮、血肌酐、碱性磷酸酶随着脂肪肝的加重而下降（F=3.46～14.54，均P<0.05）。 血红蛋白水平与年龄、血尿素氮、血肌酐呈负相关（r=-0.153、-0.222、-0.134，均P<0.01）；血红蛋白水平与谷丙 转氨酶、谷草转氨酶、血尿酸、有无脂肪肝呈正相关（r=0.238、0.132、0.107、0.239，均P<0.01）。随着血红蛋白 水平升高，NAFLD患病率呈明显升高趋势，而NAFLD的病变程度呈加重趋势（χ2=25.57，P<0.001），Q1组~Q4组的 NAFLD总患病率分别为16.2%、18.43%、21.6%和20.48%；Logistic回归分析显示，随着血红蛋白水平的升高，发生 NAFLD的风险明显增大。以Q1组作对照，Q2组的OR值为1.410（95%CI:0.848～2.345），Q3组的OR值为2.087（95%CI: 1.619～4.532）, Q4组的OR值为3.113（95%CI:1.748～5.542），差异有统计学意义。调整年龄、性别因素后，Q4组 发生NAFLD的OR值为2.507（95%CI:1.382～4.548），差异仍有统计学意义。结论:痛风合并NAFLD患者的血红蛋白水 平随着NAFLD的严重程度而呈明显升高趋势；随着血红蛋白水平的升高，NAFLD呈显著上升趋势，进一步分析显示血红 蛋白水平与NAFLD的发生有独立相关性。

Study on relationship between hemoglobin and gout combined with nonalcoholic fatty liver disease

Objective: To investigate the features of hemoglobin in gout combined with nonalcoholic fatty liver diseases(NAFLD) and the relationship between hemoglobin and NAFLD. Methods: A total of 537 patients with gout were enrolled. All patients underwent abdominal ultrasonography. According to the degree of NAFLD, the patients were divided into simple gout group, gout combined with mild NAFLD group and gout combined with moderate-severe NAFLD group. According to hemoglobin tetrad, all patients were divided into Q1 group(hemoglobin<135 g/L), Q2 group (135 g/L≤hemoglobin＜145 g/L), Q3 group (145 g/L≤ hemoglobin＜154 g/L), Q4 group (hemoglobin≥154 g/L). Height, weight, waist, hip and blood pressure were measured. Extracting the elbow venous blood, blood biochemistry parameters were measured, including blood routine examination, total cholesterol, triglyceride, high-density lipoprotein- cholesterol, low-density lipoprotein-cholesterol, liver enzyme, urea nitrogen, creatinine, uric acid, glycated hemoglobin, fasting plasma glucose, insulin. Homeostasis model evaluation- insulin resistance index (HOMA-IR) was calculated. Results: The comparison of general data among the three groups showed that the more serious the degree of NAFLD, the younger the age, the higher the BMI and waist-hip ratio. Red blood cell count, hemoglobin, hematocrit, red blood cell distribution width SD, red blood cell distribution width CV, triglyceride, alanine transaminase, aspertate aminotransferase, gamma transpeptidase, fasting plasma glucose, glycosylated hemoglobin, serum uric acid and HOMA-IR increased with the aggravation of NAFLD(F = 13.08-34.85, all P<0.05). Course of gout, the number of joints involved, platelet, serum urea nitrogen, serum creatinine and alkaline phosphatase(ALP) were decreased with the aggravation of NAFLD(F = 3.46-14.54, all P<0.05). Hemoglobin was negatively related to age, serum urea nitrogen and serum creatine（r value was -0.153, -0.222, -0.134 respectively，all P<0.01） and positively with serum uric acid, alanine transaminase, aspertate aminotransferase and NAFLD(r value was 0.238, 0.132, 0.107, 0.239，respectively, all P<0.01). The results showed that the prevalence of NAFLD was increased with increasing hemoglobin, and the degree of NAFLD became more serious( χ2=25.57 ，P<0.001). The overall prevalence of NAFLD in Q1-Q4 groups was 16.2%，18.43%，21.6%, and 20.48%, respectively. Logistic regression showed that the risk of NAFLD was increased with the increase of hemoglobin, Taking Q1 group as a control, OR of Q2 group was1.41(95%CI: 0.848-2.345), OR of Q3 group was 2.087(95%CI: 1.619-4.532), OR of Q4 group was 3.113(95%CI: 1.748-5.542). After adjusting for age and gender, OR of NAFLD in Q4 group was 2.507(95% CI: 1.382-4.548), and the difference was still statistically significant. Conclusion: The serum hemoglobin of gout combined with NAFLD increases with the severity of NAFLD. NAFLD shows a significant upward trend with the increase of hemoglobin level. Further analysis shows that serum hemoglobin is independently associated with the occurrence of NAFLD.