School of Nursing, National Taipei University of Nursing and Health Science, Taipei 112, Taiwan.
Department of Obstetrics and Gynecology, School of Medicine, College of Medicine, Taipei Medical University, Taipei 112, Taiwan.
Nutrients. 2023 Apr 14;15(8):1892. doi: 10.3390/nu15081892.
Nonalcoholic fatty liver disease (NAFLD) is highly prevalent globally and includes chronic liver diseases ranging from simple steatosis to nonalcoholic steatohepatitis (NASH). The neutrophil-to-albumin ratio (NPAR) is a cost-effective, readily available biomarker of inflammation used to assess cancer and cardiovascular disease prognosis, and it may be of predictive value in NAFLD. This study was to evaluate the associations between the NPAR, the neutrophil-to-lymphocyte ratio (NLR), and the presence of NAFLD or advanced liver fibrosis, and to assess the predictive value of the NPAR in NAFLD in a nationally representative database. This population-based, cross-sectional, retrospective study analyzed the secondary data of adults with NAFLD or advanced liver fibrosis extracted from the National Health and Nutrition Examination Survey (NHANES) database 2017-2018. NHANES participants with complete information of vibration-controlled transient elastography (VCTE) and controlled attenuation parameter (CAP) were enrolled. A logistic regression analysis was used to determine the associations between the variables in the participants with and without NAFLD or advanced liver fibrosis. The mean values of the lymphocyte counts, neutrophil counts, NPAR, aspartate aminotransaminase (AST), alanine aminotransaminase (ALT), total cholesterol, triglycerides, and HbA1c were significantly higher in the participants with NAFLD than in those without NAFLD or advanced liver fibrosis. The mean blood albumin levels of the subjects without NAFLD or advancing fibrosis were considerably greater than those of the individuals with these conditions. The mean values of the NLR, NPAR, AST, ALT, triglycerides, lymphocyte count, neutrophil count, and HbA1c were significantly higher in patients with advanced fibrosis than in those without advanced fibrosis. A multivariate analysis showed that per unit increases in both the NLR and NPAR were significantly associated with an increased risk of developing NAFLD, while neither the NLR nor NPAR was significantly associated with higher odds of advanced fibrosis. In conclusion, the novel biomarker NPAR demonstrates a good association with NAFLD, along with participants' clinical characteristics, in a nationwide population. The NPAR may serve as a biomarker for NAFLD and help clinicians refine the diagnosis and treatment of chronic liver disease.
非酒精性脂肪性肝病（NAFLD）在全球范围内高发，包括从单纯性脂肪变性到非酒精性脂肪性肝炎（NASH）等慢性肝脏疾病。中性粒细胞与白蛋白比值（NPAR）是一种经济有效的、易于获得的炎症标志物，用于评估癌症和心血管疾病的预后，并且在 NAFLD 中可能具有预测价值。本研究旨在评估 NPAR、中性粒细胞与淋巴细胞比值（NLR）与 NAFLD 或晚期肝纤维化的相关性，并评估 NPAR 在全国代表性数据库中对 NAFLD 的预测价值。这项基于人群的横断面回顾性研究分析了 2017-2018 年国家健康和营养检查调查（NHANES）数据库中提取的患有 NAFLD 或晚期肝纤维化的成年人的二级数据。纳入了具有完整振动控制瞬态弹性成像（VCTE）和受控衰减参数（CAP）信息的 NHANES 参与者。使用逻辑回归分析确定了患有和不患有 NAFLD 或晚期肝纤维化的参与者之间变量的相关性。患有 NAFLD 的参与者的淋巴细胞计数、中性粒细胞计数、NPAR、天冬氨酸转氨酶（AST）、丙氨酸转氨酶（ALT）、总胆固醇、甘油三酯和 HbA1c 的平均值明显高于不患有 NAFLD 或晚期肝纤维化的参与者。无 NAFLD 或进展性纤维化受试者的平均血白蛋白水平明显高于有这些情况的个体。晚期纤维化患者的 NLR、NPAR、AST、ALT、甘油三酯、淋巴细胞计数、中性粒细胞计数和 HbA1c 的平均值明显高于无晚期纤维化患者。多变量分析显示，NLR 和 NPAR 每单位增加与 NAFLD 的发病风险增加显著相关，而 NLR 和 NPAR 均与晚期纤维化的高几率无关。总之，在全国范围内的人群中，新型生物标志物 NPAR 与 NAFLD 及其参与者的临床特征具有良好的相关性。NPAR 可作为 NAFLD 的生物标志物，有助于临床医生改善慢性肝病的诊断和治疗。
