血尿酸与代谢相关脂肪性肝病患者肝功能异常的相关性及因果研究

目的 研究血尿酸(UA)与代谢相关脂肪性肝病(MAFLD)患者肝功能异常的相关性及因果关系。方法 纳入于四川大学华西医院就诊的MAFLD患者98例。用Spearman相关和多元Logistic回归分析UA与丙氨酸氨基转移酶(ALT)、天冬氨酸氨基转移酶(AST)间的相关性。用双向孟德尔随机化研究分析UA与ALT、AST之间的因果关系。结果 UA与ALT、AST呈正相关，相关系数分别为0.56(P<0.001)和0.46(P=0.01)。高UA组相较于低UA组ALT(OR=3.58,P=0.003)、AST(OR=3.24,P=0.005)水平增加。正向因果中，UA每升高1标准差(SD),ALT增加0.07SD(P=0.002),AST增加0.06SD(P=0.03)。而在反向因果中，尚未发现ALT、AST与UA间相关(P>0.05)。结论 UA可导致ALT、AST水平升高，是MAFLD患者肝功能受损潜在的危险因素。

Association and Causality of Blood Uric Acid and Abnormal Liver Function in Metabolic Associated Fatty Liver Disease

Objective: To investigate the correlation and causal relationship between blood uric acid and abnormal liver function in metabolic associated fatty liver disease (MAFLD).Methods: 114 patients with MAFLD were included in West China Hospital of Sichuan University. Spearman correlation and multivariate logistic regression were used to analyze the correlation between uric acid, alanine aminotransferase (ALT), and aspartate aminotransferase (AST). The causal relationship between uric acid and liver function was analyzed by Mendelian randomization.Results: Blood uric acid was positive correlated with ALT and AST, with correlation coefficients of 0.51 (P<0.001) and 0.42 (P=0.01), respectively. Higher uric acid levels significantly increased ALT and AST levels (OR: 7.39, P=0.01; OR: 3.84, P=0.05). For each 1 standard deviation (SD) increased in genetically predicted uric acid, ALT increased by 0.07 SD (P=0.002) and AST by 0.06 SD (P=0.03). However, no statistical difference has been found between ALT, AST and uric acid in reverse causation.Conclusion: Blood uric acid could cause elevated ALT and AST levels, and might be a potential risk factor for impaired liver function in patients with MAFLD.