Qin Shaoyou, Wang Jiangbin, Zhou Changyu, Zhang Yonggui, Xu Yan, Wang Xu, Wang Song
Department of Gastroenterology and Hepatology, China-Japan Union Hospital of Jilin University, Changchun, China.
Department of Urology, the First Hospital of Jilin University, Changchun, China
BMJ Open. 2019 Aug 30;9(8):e027702. doi: 10.1136/bmjopen-2018-027702.
Mounting data now support a strong link between the presence of non-alcoholic fatty liver disease (NAFLD) and an increased risk of urolithiasis. However, little is known on the association between hepatic fibrosis and the risk of urolithiasis among NAFLD patients. Therefore, this study aimed to investigate the prevalence of urolithiasis among NAFLD patients and determine whether the Fibrosis-4 (FIB-4) score, a surrogate marker of hepatic fibrosis, is associated with urolithiasis among NAFLD patients.
Cross-sectional studies.
China.
A total of 2058 adult patients with NAFLD were included in this study. Logistic regression analysis was used to detect the association between FIB-4 score and urolithiasis. Receiver operating characteristic (ROC) curve analysis was used to assess the diagnostic value of FIB-4 score for the detection of urolithiasis among NAFLD patients.
200 (9.7%) individuals had ultrasonography-diagnosed urolithiasis among 2058 NAFLD patients. FIB-4 score (OR=1.58; 95% CI 1.06 to 2.31), age (OR=1.11; 95% CI 1.08 to 1.13), obesity (OR=3.16; 95% CI 2.29 to 4.39) and hyperuricemia (OR=3.79; 95% CI 2.67 to 5.36) were independent factors associated with urolithiasis among NAFLD patients. Moreover, a novel algorithm including multiple variables (FIB-4 score, age, obesity and hyperuricemia) showed an area under a ROC curve of 0.813 (95% CI 0.795 to 0.829) for identifying urolithiasis among NAFLD patients. The optimal cut-off value of > -2.23 for the multivariate model provides a sensitivity of 76% and a specificity of 74% for predicting urolithiasis among NAFLD patients.
Urolithiasis among NAFLD patients is associated with FIB-4 score. Further, a novel algorithm based on FIB-4 score could serve as a useful tool for identifying individuals with a higher risk of urolithiasis among NAFLD patients, although prospective cohort studies are still needed in the future.
越来越多的数据表明，非酒精性脂肪性肝病（NAFLD）与尿石症风险增加之间存在密切联系。然而，关于NAFLD患者肝纤维化与尿石症风险之间的关联却知之甚少。因此，本研究旨在调查NAFLD患者中尿石症的患病率，并确定肝纤维化替代标志物Fibrosis-4（FIB-4）评分是否与NAFLD患者的尿石症相关。
横断面研究。
中国。
本研究共纳入2058例成年NAFLD患者。采用逻辑回归分析检测FIB-4评分与尿石症之间的关联。采用受试者工作特征（ROC）曲线分析评估FIB-4评分对NAFLD患者尿石症的诊断价值。
在2058例NAFLD患者中，200例（9.7%）经超声诊断为尿石症。FIB-4评分（OR=1.58；95%CI 1.06至2.31）、年龄（OR=1.11；95%CI 1.08至1.13）、肥胖（OR=3.16；95%CI 2.29至4.39）和高尿酸血症（OR=3.79；95%CI 2.67至5.36）是NAFLD患者尿石症的独立相关因素。此外，一种包含多个变量（FIB-4评分、年龄、肥胖和高尿酸血症）的新算法在识别NAFLD患者尿石症方面的ROC曲线下面积为0.813（95%CI 0.795至0.829）。多变量模型> -2.23的最佳截断值对NAFLD患者尿石症的预测敏感性为76%，特异性为74%。
NAFLD患者的尿石症与FIB-4评分相关。此外，基于FIB-4评分的新算法可作为识别NAFLD患者中尿石症风险较高个体的有用工具，尽管未来仍需要进行前瞻性队列研究。
