Metabolic associated fatty liver disease (MAFLD) is more prevalent than non-alcoholic fatty liver disease (NAFLD), leading to the identification of a variety of metabolically complex fatty liver diseases. The serum uric acid/creatinine ratio (SUA/Cr) is a new biomarker discovered after renal function-normalized SUA. At present, there have been few studies on the relationship between SUA/Cr and MAFLD.

To explore the correlation of SUA/Cr with MAFLD, and its predictive value for MAFLD.

We enrolled 2 288 individuals who visited the Physical examination Center of the Affiliated Hospital of Inner Mongolia Medical University in February to June 2023. Venous blood samples were collected for laboratory tests, and abdominal ultrasonography was used to examine the liver condition. Based on the results of abdominal ultrasonography and the diagnostic criteria for MAFLD, the subjects were divided into the MAFLD group (n=945) and non-MAFLD group (n=1 343). According to SUA/Cr quartiles, the subjects were divided into Q1 group (SUA/Cr≤4.13, n=574), Q2 group (4.13<SUA/Cr≤4.84, n=573), Q3 group (4.84<SUA/Cr≤5.72, n=570), Q4 group (SUA/Cr>5.72, n=571). Spearman rank correlation analysis was used to explore the correlation between SUA/Cr and clinical data. Binary Logistic regression analysis was used to gradually explore the influencing factors of MAFLD. Receiver operating characteristic (ROC) curve was drawn, and the area under the ROC curve (AUC) was calculated to evaluate the predictive value of SUA/Cr for MAFLD.

Compared to the non-MAFLD group, the MAFLD group had higher levels of male proportion, age, waist circumference (WC), BMI, systolic blood pressure (SBP), diastolic blood pressure (DBP), alanine aminotransferase (ALT), aspartate aminotransferase (AST), alkaline phosphatase (ALP), gamma-glutamyl transpeptidase (GGT), total cholesterol (TC), triacylglycerol (TG), low density lipoprotein cholesterol (LDL-C), fasting blood glucose (FBG), glycosylated hemoglobin (HbA_1c), homocysteine (Hcy), serum uric acid (SUA), serum creatinine (Scr), and SUA/Cr ratio (P<0.001). High-density lipoprotein cholesterol (HDL-C) in the MAFLD group was lower in the non-MAFLD group (P<0.001). In the Q4 group, the WC, BMI, ALT, GGT, SUA, TC and TG were higher than those in the Q1, Q2 and Q3 groups, the AST was higher than the Q1 and Q2 groups, the DBP, ALP and HbA_1c were higher than the Q1 group, the Scr, HDL-C were lower than those in the Q1, Q2 and Q3 groups, and the age was lower than those in the Q1 and Q2 groups (P<0.05). In the Q3 group, the ALT, AST, GGT, SUA, TC and TG were higher than those in the Q1 and Q2 groups, the WC and BMI were higher than those in the Q1 group, the Scr was lower than those in the Q1 and Q2 groups, and the age and HDL-C were lower than those in the Q1 group (P<0.05). In the Q2 group, the WC, BMI, ALT, GGT, SUA, and TG were higher than those in the Q1 group, and the age and HDL-C were lower than those in the Q1 group (P<0.05). Multivariate Logistic regression analysis showed that elevated WC (OR=1.034, 95%CI=1.016-1.053), BMI (OR=1.340, 95%CI=1.266-1.418), GGT (OR=1.006, 95%CI=1.003-1.010), SUA (OR=1.002, 95%CI=1.000-1.003), TG (OR=1.319, 95%CI=1.181-1.474), and HbA_1c (OR=1.348, 95%CI=1.184-1.536) were risk factors for MAFLD, while elevated HDL-C (OR=0.334, 95%CI=0.205-0.543) was a protective factor for MAFLD (P<0.05). After adjusting for confounding factors, the risk of MAFLD in Q4 group was 1.734 (95%CI=1.220-2.465, P=0.002) compared with Q1 group. SUA/Cr predicted that the area under the curve (AUC) of MAFLD was 0.607 (95%CI=0.584-0.630), with an optimal threshold value of 4.538.

The level of SUA/Cr in MAFLD group is higher compared to the non-MAFLD group. As the SUA/Cr level increased, the detection rate of MAFLD also increased. The SUA/Cr is a risk factor for MAFLD. The SUA/Cr can be used as a predictor to evaluate the risk of developing MAFLD.

代谢相关脂肪性肝病（MAFLD）的检出率高于非酒精性脂肪性肝病（NAFLD），可以识别出更多代谢复杂的脂肪肝疾病。血尿酸/肌酐比值（SUA/Cr）是经肾功能标准化血尿酸（SUA）后的新型生物标志物，目前，SUA/Cr与MAFLD的关系研究较少。

探讨SUA/Cr与MAFLD的相关性及其预测价值。

选取2023年2—6月在内蒙古医科大学附属医院体检中心参加健康体检的2 288例体检人群为研究对象，采集其空腹静脉血进行实验室检查，采用腹部超声检查肝脏情况。根据腹部超声检查结果及MAFLD诊断标准，将受试者分为MAFLD组（n=945）和非MAFLD组（n=1 343）。根据SUA/Cr四分位数将研究对象分为Q1组（SUA/Cr≤4.13，n=574）、Q2组（4.13<SUA/Cr≤4.84，n=573）、Q3组（4.84<SUA/Cr≤5.72，n=570）、Q4组（SUA/Cr>5.72，n=571）。采用Spearman秩相关分析探究SUA/Cr与临床资料的相关性。采用二元Logistic回归分析逐步探究MAFLD的影响因素。绘制受试者工作特征曲线（ROC），计算ROC曲线下面积（AUC）以评估SUA/Cr对MAFLD的预测价值。

MAFLD组患者男性占比、年龄、腰围（WC）、BMI、收缩压（SBP）、舒张压（DBP）、丙氨酸氨基转移酶（ALT）、天冬氨酸氨基转移酶（AST）、碱性磷酸酶（ALP）、γ-谷氨酰基转肽酶（GGT）、总胆固醇（TC）、三酰甘油（TG）、低密度脂蛋白胆固醇（LDL-C）、空腹血糖（FBG）、糖化血红蛋白（HbA_1c）、同型半胱氨酸（Hcy）、SUA、血肌酐（Scr）及SUA/Cr均高于非MAFLD组，高密度脂蛋白胆固醇（HDL-C）低于非MAFLD组（P<0.001）。Q4组WC、BMI、ALT、GGT、SUA、TC、TG高于Q1、Q2、Q3组，AST高于Q1、Q2组，DBP、ALP、HbA_1c高于Q1组，Scr、HDL-C低于Q1、Q2、Q3组，年龄低于Q1、Q2组（P<0.05）；Q3组ALT、AST、GGT、SUA、TC、TG均高于Q1、Q2组，WC、BMI高于Q1组，Scr低于Q1、Q2组，年龄、HDL-C低于Q1组（P<0.05）；Q2组WC、BMI、ALT、GGT、SUA、TG均高于Q1组，年龄、HDL-C低于Q1组（P<0.05）。多因素Logistic回归分析结果显示，高WC（OR=1.034，95%CI=1.016~1.053）、BMI（OR=1.340，95%CI=1.266~1.418）、GGT（OR=1.006，95%CI=1.003~1.010）、SUA（OR=1.002，95%CI=1.000~1.003）、TG（OR=1.319，95%CI=1.181~1.474）、HbA_1c（OR=1.348，95%CI=1.184~1.536）为MAFLD患病的危险因素，高HDL-C（OR=0.334，95%CI=0.205~0.543）为MAFLD患病的保护因素（P<0.05）。以SUA/Cr四分位数分组为自变量，调整混杂因素后，与Q1组相比，Q4组MAFLD的发生风险为1.734（95%CI=1.220~2.465，P=0.002）。SUA/Cr预测MAFLD的AUC为0.607（95%CI=0.584~0.630），最佳临界值为4.538。

MAFLD组患者SUA/Cr高于非MAFLD组，随着SUA/Cr升高，MAFLD的检出率越高，SUA/Cr是MAFLD的危险因素。SUA/Cr可以作为评估MAFLD发生风险的预测指标。