Analysis Of Clinical Features And Related Risk Factors Of Gout Combined With Abnormal Liver Function

Clinical features of gout with abnormal liver functionObjective Objective To investigate the causes and clinical featueres of abnormal liverfunction in patients with gout,and to provide a clinical basis for individualized treatment of gout patients.Methods From May 2014 to October 2017,727 patients(696 male and 31female)hospitalized for gout in our department were enrolled in this study.Their gender,onset-age,duration,family history,history of drinking,combining disease and medication were recorded.The height,weight,waist circumference,hip circumference,blood pressure of them were measured.Blood samples were collected to check blood sugar,triglyceride,total cholesterol,uric acid,creatinine,alanine aminotransferase,glycated hemoglobinand,insulin,and related indexes.The hepatic ultrasound were collected.The patients were divided into the normal liver function group with 512 patients and abnormal liver function group with 215 patients.The abnormal liver function group was further divided into non-alcoholic fatty liver disease(NAFLD)group with 112 patients,alcoholic liver disease(ALD)group with 25 patients,drug-induced liver injury(DILI)group with 42 patients,mixed(DILI+NAFLD,DILI+ALD)group with 30 patients.The clinical information and relevant biochemical indices were collected,and these groups were compared in terms of clinical features and outcome of liver-protection treatment.SPSS software was applied for the statistical analyses.Results The incidence of abnormal liver function in gout patients was 29.6%,The top four causes were NAFLD,DILI,mixed cause(DILI+NAFLD or DILI+ALD)and ALD.Compared with normal liver function group,the abnormal liver function group had a significantly younger age,a significantly shorter course of gout,and significantly higher body mass index(BMI),diastolic blood pressure,alanine aminotransferase(ALT),aspartate aminotransferase(AST),gamma-glutamyl transpeptidase(GGT),creatinine clearance rate(Ccr),triglyceride(TG),total cholesterol(TC)(t=-4.53?7.48,P<0.01).There were no significant differences in systolic blood pressure,blood glucose,direct bilirubin(DBIL),indirect bilirubin(IBIL),uric acid(UA)and low density lipoprotein cholesterol(LDL-C)between the two groups(P>0.05).NAFLD group had a significantly younger age,a significantly shorter course and a significantly lower levels of AST than ALD,DILI and mixed groups,as well as significantly higher BMI,weight,UA,LDL-C,TC and Ccr than the ALD and DILI groups(F=3.19?12.18,P<0.01).The ALD group had significantly higher AST/ALT ratio and GGT level than the NAFLD,DILI and mixed groups(F=5.86?12.15,P<0.01).The DILI group and the mixed group had a significantly higher lever of ALT than the NAFLD and ALD group(F=4.93,P<0.01).After liver-protection treatment,the DILI group had the most rapid reduction in ALT,the ALDgroup had the most rapid reduction in GGT,and the NAFLD had a significantly less reduction in AST than the DILI group and the ALD group(F=3.42?5.79,P<0.05).Among the common drugs that caused abnormal liver function in gout patients,NSAIDs ranks the first,followed by febuxostat,colchicine and traditional Chinese medicine.Conclusion There is a high incidence rate of abnormal liver function in patients with gout,with NAFLD as the primary cause.NAFLD patients have the features of early age of onset,obesity,high UA and high blood lipids.Patients with DILI and ALD have good response to liver-protection treatment,while those with NAFLD have poor response.Analysis of risk factors for susceptibility of abnormal liver function in male patients with goutObjective : Obesity,fatty liver,diabetes and other components of metabolic syndrome(MS)have been proved to be related to abnormal liver function,while hyperuricemia was closely related to MS.However,there were few studies on hyperuricemia or gout and abnormal liver function.In our previous study,the incidence of abnormal liver function in gout patients was 29.6%,much higher than that in the general population.To investigate the risk factors for susceptibility of abnormal liver function in patients with gout.Methods:A total of 5044 cases of male gout patients in remission were selected(patients were required to be in gout remission period,and had not taken any analgesic drugs or uric acid-lowering drugs within 6 months,and the combined drugs had not been adjusted within 3 months).Patients with previous viral hepatitis,autoimmune liver diseases,bile duct diseases,tumors and other diseases that caused abnormal liver function were excluded.Their gender,onset-age,duration,family history,previous treatment history,history of smoking,history of drinking,and combining disease were recorded.The height,weight,waist circumference,hip circumference,blood pressure of them were measured.Blood samples were collected to check blood sugar,triglyceride,total cholesterol,uric acid,creatinine,alanine aminotransferase and related biochemical indexes.They were divided into normal liver function group with 3693 patients and abnormal liver function group with 1351 patients.The SPSS software was applied for statistical analysis to compare the differences between the two groups.Logistic regression was used for analysis related risk factors.SUA was divided into quartiles,and its associations with elevated ALT were evaluated by multiple linear regressionResults : There were significant differences in the history of drinking,family history,combining hyperlipemia,fatty liver and coronary heart disease between the abnormal liver function group and normal function group(P<0.05 or P<0.01).There were significant statistical differences in age,disease duration,body mass index,waist circumference,diastolic blood pressure,serum cholesterol and triglyceride,uric acid,creatinine clearance rate between two groups(P<0.01),but no significant differences in history of smoking,regular exercise,combining hypertension and diabetes,the means of systolic blood pressure,fasting blood and serum creatinine(P>0.05).Further logistic regression analysis indicated that body mass,waistline,combining fatty liver,higher serum uric acid level,higher cholesterol and triglyceride were risk factors of the early onset of abnormal liver funtion.ALT and the proportion of abnormal liver function were increased with the increase of UA;After adjustment for BMI,TG,TC and fatty liver,the ALT level and the proportion of abnormal liver function decreased significantly and still showed an upward trend.Conclusion Patients with obesity,high level of uric acid,high blood lipids and fatty liver were more likely to develop abnormal liver function,SUA was independently associated with elevated ALT.