Guo Xiu Li, Tu Mei, Qiu Xiu Ping, Wang Wei
National Metabolic Management Center, Longyan First Affiliated Hospital of Fujian Medical University, Longyan, Fujian, China.
Front Endocrinol (Lausanne). 2025 Jun 4;16:1619003. doi: 10.3389/fendo.2025.1619003. eCollection 2025.
Recent evidence suggests that the serum uric acid to apolipoprotein A1 ratio (UAR) may be a novel biomarker for metabolic dysfunction-associated steatotic liver disease (MASLD). This study aims to investigate the relationship between UAR and MASLD, and compare the diagnostic ability of UAR with other insulin resistance-related markers for MASLD in individuals with type 2 diabetes mellitus (T2DM).
A cohort of 1,019 individuals with T2DM was recruited from the National Metabolic Management Center of our hospital. Unenhanced abdominal CT scans were performed to evaluate liver steatosis for diagnosing MASLD. The association between UAR and the risk of MASLD was analyzed using weighted binomial logistic regression, restricted cubic splines (RCS), and subgroup analysis. Receiver operating characteristic (ROC) curve analysis was conducted to compare the diagnostic performance of UAR with other insulin resistance-related markers, including the serum uric acid to high-density lipoprotein cholesterol ratio (UHR), triglyceride to high-density lipoprotein cholesterol ratio (THR), and triglyceride to apolipoprotein A1 ratio (TAR).
Participants in the MASLD group exhibited elevated UAR levels. After full adjustments for potential confounders, UAR remained independently associated with MASLD ( 1.65, 95% CI: 1.45-1.89, < 0.001). Subgroup analyses revealed that this association was consistent across various subgroups, including sex, drinking status, hypertension, lipid-lowering therapy, and body mass index ( < 0.05). RCS analysis demonstrated a linear increase in the risk of MASLD with higher UAR levels ( for nonlinear = 0.319). ROC curve analysis indicated that UAR provided good diagnostic performance for MASLD (AUC:0.777, 95% CI: 0.749- 0.805), comparable to TAR (AUC difference: -0.003, 95% CI: -0.033-0.026, = 0.818) and superior to UHR (AUC difference: 0.043, 95% CI: 0.019-0.067, < 0.001) and THR (AUC difference: 0.035, 95% CI: 0.019-0.067, = 0.047).
UAR was independently associated with MASLD and demonstrated significant diagnostic value, indicating that UAR could be a cost-effective biomarker to help identify high-risk individuals for MASLD.
近期证据表明，血清尿酸与载脂蛋白A1比值（UAR）可能是代谢功能障碍相关脂肪性肝病（MASLD）的一种新型生物标志物。本研究旨在探讨UAR与MASLD之间的关系，并比较UAR与其他胰岛素抵抗相关标志物对2型糖尿病（T2DM）患者MASLD的诊断能力。
从我院国家代谢管理中心招募了1019例T2DM患者。进行腹部平扫CT扫描以评估肝脏脂肪变性，用于诊断MASLD。采用加权二项逻辑回归、限制性立方样条（RCS）和亚组分析来分析UAR与MASLD风险之间的关联。进行受试者工作特征（ROC）曲线分析，以比较UAR与其他胰岛素抵抗相关标志物的诊断性能，这些标志物包括血清尿酸与高密度脂蛋白胆固醇比值（UHR）、甘油三酯与高密度脂蛋白胆固醇比值（THR）以及甘油三酯与载脂蛋白A1比值（TAR）。
MASLD组参与者的UAR水平升高。在对潜在混杂因素进行全面调整后，UAR仍与MASLD独立相关（比值比为1.65，95%置信区间：1.45 - 1.89，P < 0.001）。亚组分析显示，这种关联在包括性别、饮酒状况、高血压、降脂治疗和体重指数等各个亚组中都是一致的（P < 0.05）。RCS分析表明，随着UAR水平升高，MASLD风险呈线性增加（非线性检验P = 0.319）。ROC曲线分析表明，UAR对MASLD具有良好的诊断性能（曲线下面积：0.777，95%置信区间：0.749 - 0.805），与TAR相当（曲线下面积差异：-0.003，95%置信区间：-0.033 - 0.026，P = 0.818），且优于UHR（曲线下面积差异：0.043，95%置信区间：0.019 - 0.067，P < 0.001）和THR（曲线下面积差异：0.035，95%置信区间：0.019 - 0.067，P = 0.047）。
UAR与MASLD独立相关，并显示出显著的诊断价值，表明UAR可能是一种经济有效的生物标志物，有助于识别MASLD的高危个体。
