Jaruvongvanich Veeravich, Ahuja Wasin, Wirunsawanya Kamonkiat, Wijarnpreecha Karn, Ungprasert Patompong
aDepartment of Internal Medicine, University of Hawaii, Honolulu, Hawaii bDepartment of Internal Medicine, Norwalk Hospital, Norwalk, Connecticut cDepartment of Internal Medicine, Bassett Medical Center and Columbia University College of Physicians and Surgeons, Cooperstown, New York dDepartment of Internal Medicine, Division of Rheumatology, Mayo Clinic, Rochester, Minnesota, USA eDepartment of Medicine, King Chulalongkorn Memorial Hospital fDepartment of Medicine, Division of Rheumatology, Faculty of Medicine Siriraj Hospital, Mahidol University, Bangkok, Thailand.
Eur J Gastroenterol Hepatol. 2017 Sep;29(9):1031-1035. doi: 10.1097/MEG.0000000000000931.
Hyperuricemia is a significant risk factor for nonalcoholic fatty liver disease (NAFLD). It may also have an impact on the histologic severity of NAFLD. However, data on this association are limited. We conducted this meta-analysis to investigate the relationship of serum uric acid with liver histologic severity as determined by NAFLD activity score (NAS) in patients with NAFLD.
MEDLINE and EMBASE databases were searched through August 2016 for studies that investigated the association between hyperuricemia and NAS among patients with biopsy-proven NAFLD. Pooled odds ratio and 95% confidence interval were calculated using a random-effects model (generic inverse variance method). The between-study heterogeneity of effect size was quantified using the Q statistic and I.
Five observational studies with 777 NAFLD patients were identified. Patients with NAFLD who had hyperuricemia had a high NAS (defined as score of ≥5) significantly more often than did those without hyperuricemia with a pooled odds ratio of 2.17 (95% confidence interval: 1.51-3.12). The statistical heterogeneity was low, with I of 16% (Pheterogeneity=0.31).
In patients with NAFLD, hyperuricemia is associated with a higher degree of histological liver damage. Further studies are required to establish the role of uric acid-lowering therapy among these patients.
高尿酸血症是非酒精性脂肪性肝病（NAFLD）的一个重要危险因素。它也可能对NAFLD的组织学严重程度产生影响。然而，关于这种关联的数据有限。我们进行了这项荟萃分析，以研究血清尿酸与经NAFLD活动评分（NAS）确定的NAFLD患者肝脏组织学严重程度之间的关系。
检索MEDLINE和EMBASE数据库至2016年8月，以查找研究经活检证实的NAFLD患者中高尿酸血症与NAS之间关联的研究。使用随机效应模型（通用逆方差法）计算合并比值比和95%置信区间。使用Q统计量和I2对效应大小的研究间异质性进行量化。
确定了五项观察性研究，共777例NAFLD患者。患有高尿酸血症的NAFLD患者NAS较高（定义为评分≥5）的情况显著多于无高尿酸血症的患者，合并比值比为2.17（95%置信区间：1.51 - 3.12）。统计异质性较低，I2为16%（异质性P = 0.31）。
在NAFLD患者中，高尿酸血症与肝脏组织学损伤程度较高相关。需要进一步研究以确定降尿酸治疗在这些患者中的作用。
