Wang Liping, Dong Jinzhong, Xu Miao, Li Li, Yang Naibin, Qian Guoqing
Department of Infectious Diseases, Ningbo First Hospital, Ningbo University, Ningbo, China.
Department of Hepatology, Non-alcoholic Fatty Liver Disease (NAFLD) Research Center, Ningbo Hospital of Zhejiang University, Ningbo, China.
Front Med (Lausanne). 2022 May 19;9:898931. doi: 10.3389/fmed.2022.898931. eCollection 2022.
Non-alcoholic fatty liver disease (NAFLD) is a global health problem affecting more than a quarter of the entire adult population. Both monocytes and high-density lipoprotein cholesterol (HDL-C) were found to participate in the progression of hepatic inflammation and oxidative stress. We speculated that the monocyte-to-HDL-C ratio (MHR) may be associated with the risk of NAFLD.
We conducted a cross-sectional study using data from the National Health and Nutrition Examination Survey (NHANES) 2017-2018. NAFLD was identified using a controlled attenuation parameter (CAP) of ≥274 dB/m. Degree of liver fibrosis were assessed by liver stiffness measurement (LSM) and LSM values≥8.0, ≥ 9.7, and ≥13.7 kPa were defined as significant fibrosis (≥F2), advanced fibrosis (≥F3) and cirrhosis (F4), respectively. The association between MHR and the risk of NAFLD and liver fibrosis was estimated using weighted multivariable logistic regression. The non-linear relationship between MHR and the risk of NAFLD was further described using smooth curve fittings and threshold effect analysis.
Of 4,319 participants, a total of 1,703 (39.4%) participants were diagnosed with NAFLD. After complete adjustment for potential confounders, MHR was positively associated with the risk of NAFLD (OR = 2.87, 95% CI: 1.95-4.22). The risk of NAFLD increased progressively as the MHR quarter increased ( for trend < 0.001). In subgroup analysis stratified by sex, a positive association existed in both sexes; Women displayed higher risk (men: OR = 2.12, 95% CI: 1.33-3.39; women: OR = 2.64, 95%CI: 1.40-4.97). MHR was positively associated with the risk of significant liver fibrosis (OR = 1.60, 95% CI: 1.08-2.37) and cirrhosis (OR = 1.83, 95% CI: 1.08-3.13), but not with advanced liver fibrosis (OR = 1.53, 95% CI: 0.98-2.39) after full adjustment for potential confounders. In the subgroup analysis by sex, the association between MHR and different degrees of liver fibrosis was significantly positive in women. When analyzing the relationship between MHR and NAFLD risk, a reverse U-shaped curve with an inflection point of 0.36 for MHR was found in women.
Higher MHR was associated with increased odds of NAFLD among Americans of both sexes. However, an association between MHR and liver fibrosis was found mainly among women.
非酒精性脂肪性肝病（NAFLD）是一个全球性健康问题，影响着超过四分之一的成年人口。单核细胞和高密度脂蛋白胆固醇（HDL-C）均被发现参与肝脏炎症和氧化应激的进展。我们推测单核细胞与HDL-C比值（MHR）可能与NAFLD风险相关。
我们利用2017 - 2018年美国国家健康与营养检查调查（NHANES）的数据进行了一项横断面研究。使用≥274 dB/m的受控衰减参数（CAP）来识别NAFLD。通过肝脏硬度测量（LSM）评估肝纤维化程度，LSM值≥8.0 kPa、≥9.7 kPa和≥13.7 kPa分别被定义为显著纤维化（≥F2）、进展性纤维化（≥F3）和肝硬化（F4）。使用加权多变量逻辑回归估计MHR与NAFLD风险及肝纤维化之间的关联。使用平滑曲线拟合和阈值效应分析进一步描述MHR与NAFLD风险之间的非线性关系。
在4319名参与者中，共有1703名（39.4%）参与者被诊断为NAFLD。在对潜在混杂因素进行完全调整后，MHR与NAFLD风险呈正相关（OR = 2.87，95% CI：1.95 - 4.22）。随着MHR四分位数增加，NAFLD风险逐渐升高（趋势P < 0.001）。在按性别分层的亚组分析中，两性均存在正相关；女性显示出更高风险（男性：OR = 2.12，95% CI：1.33 - 3.39；女性：OR = 2.64，95% CI：1.40 - 4.97）。在对潜在混杂因素进行完全调整后，MHR与显著肝纤维化风险（OR = 1.60，95% CI：1.08 - 2.37）和肝硬化风险（OR = 1.83，95% CI：1.08 - 3.13）呈正相关，但与进展性肝纤维化风险无关（OR = 1.53，95% CI：0.98 - 2.39）。在按性别进行的亚组分析中，MHR与不同程度肝纤维化之间的关联在女性中显著为正。在分析MHR与NAFLD风险的关系时，发现女性中MHR的拐点为0.36时呈倒U形曲线。
较高的MHR与美国两性人群中NAFLD几率增加相关。然而，MHR与肝纤维化之间的关联主要在女性中发现。
