Tang Chuanzhi, Peng Dadi, Zong Kezhen, Wu Zhongjun, Gong Miao, Li Hui, Huang Zuotian, Li Shanshan
Division of Hepatobiliary Pancreatic Surgery, First Affiliated Hospital, Chongqing Medical University, Chongqing, 400000, China.
Chongqing University Cancer Hospital, Chongqing, 400000, China.
BMC Gastroenterol. 2024 Dec 23;24(1):470. doi: 10.1186/s12876-024-03565-5.
Metabolic dysfunction-associated steatotic liver disease (MASLD) is a liver disease that is strongly associated with chronic low-grade inflammation. Stage 3 of MASLD is characterized by excessive formation of connective tissues, commonly referred to as liver fibrosis. Although numerous inflammatory markers have been identified and extensively studied, including the tumor necrosis factor-α and interleukin-6 have been studied [Byrne CD, Targher G. NAFLD: a multisystem disease. J Hepatol. 2015;62(1 Suppl):S47-64], the lymphocyte-to-high-density lipoprotein ratio (LHR) as a new biomarker that has not been sufficiently studied. This study aims to investigate the relationship between LHR levels and MASLD, determine its potential as a predictive marker for steatosis and fibrosis stages.
This was a population-based study using data from 15,560 participants in the 2017-2020 National Health and Nutrition Examination Survey (NHANES) database. The study aimed to explore the relationship between LHR and MASLD. The disease progression was tracked by continuously measuring CAP and liver stiffness measurements. Participants who exhibited a median Controlled Attenuation Parameter (CAP) of 248 dB/m or higher were deemed to have hepatic steatosis. The LHR was calculated by dividing the lymphocyte count by the high-density lipoprotein cholesterol (HDL-C) level. Multivariate linear regression models were employed to explore the linear association between LHR and MASLD. Fitted smoothing curves and threshold effect analysis were employed to display nonlinear relationships. A two-part linear regression model was employed to estimate threshold effects. Subgroup analyses were conducted to determine the consistency of this association across various demographic groups.
A total of 6,950 adults aged 18 years and older were enrolled in the study, with an average age of 48.15 ± 17.10 years (49.14% male, 50.86% female). The adjusted multiple logistic regression analysis revealed a significant positive correlation between LHR and MASLD (OR: 1.64, 95% CI: 1.40-1.92). Using the complex two-piece linear regression model, we observed an inverted L-shaped association between LHR and CAP, suggesting a critical inflection point at -2.58. Subgroup analyses indicated a pronounced association of the LHR index with obese individuals (OR: 1.96, 95% CI: 1.66-2.32) and females (OR: 1.76, 95% CI: 1.25-2.46). There was no significant association between LHR and clinically significant fibrosis.
The LHR index is positively correlated with MASLD among US adults. Therefore, LHR may be a robust marker for early screening, diagnosis, and monitoring of treatment efficacy in clinical practice.
代谢功能障碍相关脂肪性肝病（MASLD）是一种与慢性低度炎症密切相关的肝脏疾病。MASLD的3期特征是结缔组织过度形成，通常称为肝纤维化。尽管已经鉴定并广泛研究了许多炎症标志物，包括肿瘤坏死因子-α和白细胞介素-6[Byrne CD，Targher G.非酒精性脂肪性肝病：一种多系统疾病。《肝脏病学杂志》。2015；62(1增刊)：S47-64]，但淋巴细胞与高密度脂蛋白比值（LHR）作为一种新的生物标志物尚未得到充分研究。本研究旨在探讨LHR水平与MASLD之间的关系，确定其作为脂肪变性和纤维化阶段预测标志物的潜力。
这是一项基于人群的研究，使用了2017-2020年国家健康与营养检查调查（NHANES）数据库中15560名参与者的数据。该研究旨在探讨LHR与MASLD之间的关系。通过连续测量受控衰减参数（CAP）和肝脏硬度测量来跟踪疾病进展。CAP中位数为248 dB/m或更高的参与者被视为患有肝脂肪变性。LHR通过将淋巴细胞计数除以高密度脂蛋白胆固醇（HDL-C）水平来计算。采用多变量线性回归模型探讨LHR与MASLD之间的线性关联。使用拟合平滑曲线和阈值效应分析来显示非线性关系。采用两部分线性回归模型估计阈值效应。进行亚组分析以确定该关联在不同人口统计学组中的一致性。
共有6950名18岁及以上的成年人参与了该研究，平均年龄为48.15±17.10岁（男性49.14%，女性50.86%）。调整后的多变量逻辑回归分析显示LHR与MASLD之间存在显著正相关（OR：1.64，95%CI：1.40-1.92）。使用复杂的两部分线性回归模型，我们观察到LHR与CAP之间呈倒L形关联，表明临界拐点为-2.58。亚组分析表明LHR指数与肥胖个体（OR：1.96，95%CI：1.66-2.32）和女性（OR：1.76，95%CI：1.25-2.46）之间存在显著关联。LHR与临床显著纤维化之间无显著关联。
在美国成年人中，LHR指数与MASLD呈正相关。因此，LHR可能是临床实践中早期筛查、诊断和监测治疗效果的有力标志物。
