Bi Lingge, Liang Jinguang, Hu Kai
Department of Respiratory and Critical Care Medicine, Huangpu People's Hospital of Zhongshan, Zhongshan, Guangdong, 528429, China.
Department of Cerebrovascular Intervention, Zhongshan People's Hospital, Zhongshan, Guangdong, 528400, China.
BMC Pulm Med. 2025 May 29;25(1):269. doi: 10.1186/s12890-025-03701-1.
This study aimed to access the neutrophil percentage-to-albumin ratio (NPAR) as a potential biomarker for asthma risk and to explore its association with asthma incidence in a nationally representative adult population.
We analyzed cross-sectional data from 17,800 adults in the National Health and Nutrition Examination Survey (NHANES 2009-2018). NPAR was calculated as the ratio of neutrophil percentage to serum albumin concentration. Multivariable logistic regression models adjusted for demographic, socioeconomic, clinical, and laboratory covariates were employed to assess NPAR-asthma associations. Missing data were addressed via multiple imputations, and model performance was evaluated using receiver operating characteristic (ROC) curves with bootstrap validation. Restricted cubic splines analyzed non-linear relationships, while subgroup analyses tested effect heterogeneity across demographic and clinical strata. Sensitivity analyses compared complete-case and imputed datasets.
Elevated NPAR levels were strongly associated with increased asthma risk. In fully adjusted models, each one-unit increase in NPAR corresponded to a 2.6% rise in asthma prevalence (adjusted OR = 1.026, 95% CI: 1.008-1.045, P = 0.0046). ROC curve analysis demonstrated an AUC of 0.699 for NPAR in predicting asthma. Subgroup analyses revealed effect modification by sex, race, and cardiovascular disease history, though interaction terms did not meet Bonferroni-adjusted significance thresholds. Restricted cubic spline analyses indicated a U-shaped dose-response relationship, with minimal risk observed at NPAR values of 12-15, suggesting dual pathological mechanisms: oxidative stress susceptibility at lower NPAR values and neutrophilic inflammation dominance at higher values.
This study provides the first epidemiological evidence supporting NPAR as an independent biomarker for asthma risk. The U-shaped association highlights the complex interplay between systemic inflammation and oxidative stress in asthma pathogenesis. While NPAR offers a cost-effective and accessible tool for risk stratification, its moderate predictive performance underscores the need for complementary biomarkers to enhance clinical utility. Future research should integrate serial NPAR measurements and multi-omics profiling to validate its role in asthma management.
本研究旨在评估中性粒细胞百分比与白蛋白比值（NPAR）作为哮喘风险潜在生物标志物的情况，并在具有全国代表性的成年人群中探讨其与哮喘发病率的关联。
我们分析了国家健康与营养检查调查（NHANES 2009 - 2018）中17800名成年人的横断面数据。NPAR计算为中性粒细胞百分比与血清白蛋白浓度的比值。采用针对人口统计学、社会经济、临床和实验室协变量进行调整的多变量逻辑回归模型来评估NPAR与哮喘的关联。通过多重插补处理缺失数据，并使用经自抽样验证的受试者工作特征（ROC）曲线评估模型性能。受限立方样条分析非线性关系，亚组分析检验不同人口统计学和临床分层中的效应异质性。敏感性分析比较了完整病例数据集和插补数据集。
NPAR水平升高与哮喘风险增加密切相关。在完全调整模型中，NPAR每增加一个单位，哮喘患病率相应增加2.6%（调整后的OR = 1.026，95% CI：1.008 - 1.045，P = 0.0046）。ROC曲线分析显示NPAR预测哮喘的AUC为0.699。亚组分析揭示了性别、种族和心血管疾病史对效应的修饰作用，尽管交互项未达到经邦费罗尼校正的显著性阈值。受限立方样条分析表明存在U型剂量反应关系，在NPAR值为12 - 15时观察到风险最小，提示存在双重病理机制：较低NPAR值时的氧化应激易感性和较高值时的中性粒细胞炎症主导。
本研究提供了首个支持NPAR作为哮喘风险独立生物标志物的流行病学证据。U型关联突出了哮喘发病机制中全身炎症与氧化应激之间复杂的相互作用。虽然NPAR为风险分层提供了一种经济有效且可获取的工具，但其适度的预测性能强调了需要补充生物标志物以提高临床实用性。未来研究应整合连续的NPAR测量和多组学分析，以验证其在哮喘管理中的作用。
