Division of Rheumatology, Department of Medicine, Spencer Fox Eccles School of Medicine, University of Utah, Salt Lake City, UT, USA.
Department of Medicine, Rutgers-Robert Wood Johnson School of Medicine, New Brunswick, NJ, USA.
Clin Exp Rheumatol. 2024 Jan;42(1):86-91. doi: 10.55563/clinexprheumatol/am70uf. Epub 2023 Jul 24.
It has been suggested that gout is associated with non-alcoholic fatty liver disease (NAFLD). Our aim was to assess NAFLD in gout patients using the validated non-invasive imaging technique, transient elastography (FibroScan).
FibroScans in consecutive gout patients in a single centre from 11/1/2016 to 11/1/2021 and reviewed retrospectively. FibroScan results include the E- score (kPA), measuring liver stiffness, and controlled attenuation parameter (CAP) score (dB/m), assessing steatosis. In addition, a FIB-4 fibrosis score was calculated.
47 gout patients (7 females, 14.9%; 40 males, 85.1%) underwent FibroScans. The mean age was 59.8 years, the mean body mass index (BMI) was 30.95 kg/m2, and gout duration 0-49 years. Tophi were present in 11 (26.2%). Comorbidities included dyslipidaemia (86.7%), diabetes mellitus (31.1%), known liver disease (33.3%), current alcohol consumption (46.8%), ALT or AST elevations (54.4%), and hyperuricaemia (53.7%). FibroScan results revealed hepatic steatosis (CAP >238 dB/m) in 40 (85.1%) and were significantly associated with BMI (r=0.53, p=0.0001) but not age, serum urate (SU), glucose, triglycerides, ALT, AST. FibroScan also revealed fibrosis (E score >7) in 9 (19.1%); severe fibrosis (cirrhosis) in 8. Fibrosis was significantly associated with age (p=0.03) and known liver disease (p=0.003) but not BMI, SU, or comorbidities. The FIB-4 score was significantly associated with the fibrosis score (r2=0.24, p=0.0009) but not with CAP, ALT, or AST.
Despite not being associated with common gout comorbidities, fatty liver and liver fibrosis were common in this gout cohort, suggesting FibroScan screening in gout patients to assess NAFLD, irrespective of serum transaminase levels.
有研究表明痛风与非酒精性脂肪性肝病（NAFLD）有关。本研究旨在使用经过验证的无创影像学技术——瞬时弹性成像（FibroScan）评估痛风患者的 NAFLD。
回顾性分析 2016 年 11 月 1 日至 2021 年 11 月 1 日在单一中心连续就诊的痛风患者的 FibroScan 结果。FibroScan 结果包括 E 评分（kPa），用于测量肝硬度，以及受控衰减参数（CAP）评分（dB/m），用于评估脂肪变性。此外，还计算了 FIB-4 纤维化评分。
47 例痛风患者（7 名女性，占 14.9%；40 名男性，占 85.1%）接受了 FibroScan 检查。患者平均年龄为 59.8 岁，平均体重指数（BMI）为 30.95kg/m2，痛风病程 0-49 年。11 例（26.2%）患者存在痛风石。合并症包括血脂异常（86.7%）、糖尿病（31.1%）、已知肝脏疾病（33.3%）、当前饮酒（46.8%）、丙氨酸氨基转移酶（ALT）或天门冬氨酸氨基转移酶（AST）升高（54.4%）和高尿酸血症（53.7%）。FibroScan 结果显示 40 例（85.1%）存在肝脂肪变性（CAP＞238dB/m），且与 BMI 显著相关（r=0.53，p=0.0001），但与年龄、血尿酸（SU）、血糖、甘油三酯、ALT、AST 无关。FibroScan 还显示 9 例（19.1%）存在纤维化（E 评分＞7），8 例（16.7%）存在严重纤维化（肝硬化）。纤维化与年龄（p=0.03）和已知肝脏疾病（p=0.003）显著相关，但与 BMI、SU 或合并症无关。FIB-4 评分与纤维化评分显著相关（r2=0.24，p=0.0009），但与 CAP、ALT 或 AST 无关。
尽管痛风的常见合并症与脂肪肝和肝纤维化无关，但在本痛风队列中，脂肪肝和肝纤维化很常见，提示无论血清转氨酶水平如何，都应使用 FibroScan 筛查痛风患者以评估 NAFLD。
