2024 年第 5 期 第 0 卷

非酒精性脂肪性肝病患者血尿酸水平与心房颤动的相关性研究

Correlation research between serum uric acid level and atrial fibrillation in patients with non-alcoholic fatty liver disease

作者：张琪 李宝杰 周萌 刘改珍

英文作者：Zhang Qi Li Baojie Zhou Meng Liu Gaizhen

单位：山西医科大学第二医院心血管内科，太原030001

英文单位：Department of Cardiovascular Medicine Second Hospital of Shanxi Medical University Taiyuan 030001 China

关键词：非酒精性脂肪性肝病；心房颤动；血尿酸；氧化应激

英文关键词：Non-alcoholicfattyliverdisease;Atrialfibrillation;Serumuricacid;Oxidativestress

• 摘要：

• 目的  探讨非酒精性脂肪性肝病（NAFLD）患者血尿酸水平与心房颤动的相关性。方法  回顾性选取2020年1月至2022年12月于山西医科大学第二医院诊断为NAFLD的患者565例，根据是否合并心房颤动将其分为心房颤动组（224例）和非心房颤动组（341例）。分析2组患者的临床资料。多因素Logistic回归分析用于确定NAFLD患者心房颤动发生的相关因素。使用趋势性检验分析血尿酸水平与心房颤动之间的线性趋势。构建列线图模型预测心房颤动的发生风险，绘制校准曲线来评价列线图的准确性。最后绘制受试者工作特征（ROC）曲线，评估血尿酸和列线图模型对NAFLD患者心房颤动发生的预测价值。结果  多因素Logistic回归结果显示，年龄（比值比=1.096，95%置信区间：1.071~1.121，P<0.001）、血肌酐（比值比=1.021，95%置信区间：1.003~1.039，P=0.025）及血尿酸（比值比=1.008，95%置信区间：1.005~1.011，P<0.001）是NAFLD患者心房颤动发生的独立危险因素，高密度脂蛋白（P=0.010）是独立保护因素。心房颤动的风险随着血尿酸水平的升高而增加（趋势性检验P<0.001）。列线图模型预测心房颤动的C指数为0.827（95%置信区间：0.793~0.861），Hosmer-Lemeshow检验和校准图均显示该模型的校准度良好。ROC分析显示列线图模型的曲线下面积为0.827，优于血尿酸的0.683。结论  血尿酸水平升高是NAFLD患者心房颤动发生的独立危险因素。

• Objective  To investigate the correlation between serum uric acid level and atrial fibrillation in patients with non-alcoholic fatty liver disease (NAFLD). Methods  A total of 565 patients diagnosed with NAFLD in the Second Hospital of Shanxi Medical University from January 2020 to December 2022 were retrospectively selected. According to whether they were complicated with atrial fibrillation, they were divided into atrial fibrillation group (224 cases) and non-atrial fibrillation group (341 cases).The clinical data of the two groups were analyzed. Multivariate Logistic regression analysis was used to determine the related factors for the occurrence of atrial fibrillation in NAFLD patients.A trend test was used to analyze the linear trend between serum uric acid level and atrial fibrillation.The nomogram model was constructed to predict the risk of atrial fibrillation, and the calibration curve was drawn to evaluate the accuracy of the nomogram.Finally, the receiver operating characteristic (ROC) curve was drawn to evaluate the predictive value of serum uric acid and the nomogram model for the occurrence of atrial fibrillation in NAFLD patients. Results  Multivariate Logistic regression analysis showed that age ［odds ratio (OR)=1.096, 95% confidence interval (CI):1.071-1.121, P<0.001］, serum creatinine (OR=1.021, 95%CI:1.003-1.039, P=0.025) and serum uric acid (OR=1.008, 95%CI:1.005-1.011, P<0.001) were independent risk factors for the occurrence of atrial fibrillation in NAFLD patients, and high-density lipoprotein (P=0.010) was an independent protective factor. The risk of atrial fibrillation increased with the increase of serum uric acid level (P<0.001 for trend test). The C-index of the nomogram predicted atrial fibrillation was 0.827(95%CI:0.793-0.861), and the Hosmer-Lemeshow test and calibration plots showed that the model was well calibrated. ROC analysis showed that the area under the curve of the nomogram model was 0.827, which was better than that of serum uric acid (0.683). Conclusion  Elevated serum uric acid level is an independent risk factor for atrial fibrillation in patients with NAFLD.