美国血清乳酸脱氢酶水平与非酒精性脂肪性肝病及晚期肝纤维化的关联：一项利用2007年至2018年美国国家健康与营养检查调查（NHANES）数据的横断面研究

Association of serum lactate dehydrogenase levels with non-alcoholic fatty liver disease and advanced hepatic fibrosis in the United States: a cross-sectional study using NHANES data from 2007 to 2018.

作者信息

Zhang Xiaotong, Liu Min, Huang Junjun, Zheng Ya, Wang Yuping, Zhou Yongning

机构信息

The First Clinical Medical College, Lanzhou University, Lanzhou, Gansu, 730000, China.

Department of Gastroenterology, The First Hospital of Lanzhou University, Lanzhou, Gansu, 730000, China.

出版信息

BMC Gastroenterol. 2025 Jul 1;25(1):467. doi: 10.1186/s12876-025-04057-w.

DOI:10.1186/s12876-025-04057-w

PMID:40597710

原文链接:https://pmc.ncbi.nlm.nih.gov/articles/PMC12210684/

Abstract

BACKGROUND

The associations between LDH and non-alcoholic fatty liver disease (NAFLD), as well as advanced hepatic fibrosis (AHF), have not been explored. This study aims to investigate the association between log-transformed LDH levels and the prevalence of NAFLD and AHF.

METHODS

In this cross-sectional study, after applying specific criteria for inclusion and exclusion, a total of 7,316 individuals were chosen from the 59,842 participants for the final analysis. LDH levels were measured using an enzymatic rate method. A fatty liver index (FLI) greater than or equal to 60 and an NAFLD fibrosis score (NFS) higher than 0.676 were found to be indicative of hepatic steatosis and advanced hepatic fibrosis. Both weighted multivariable linear and logistic regression analyses were used to finish the study. Moreover, additional analyses were performed utilizing weighted stratified analysis and weighted smoothed curve fitting using the generalized additive model (GAM).

RESULTS

Following data analysis, the multivariable regression model 3 showed a significant association between the elevated log-transformed LDH levels and AHF (OR: 3.087, 95% CI: 1.378-6.915, P = 0.007). Furthermore, a modest association was observed between log-transformed LDH tertiles and FLI (β = 0.965, 95% CI: 0.014-1.916, P = 0.047). However, there was no evidence to prove that there was an association between log-transformed LDH levels and NAFLD in model 3. The weighted smoothed curve fitting using the GAM suggested a linear dose-response effect between log-transformed LDH levels and an increased risk of NAFLD, as well as a non-linear relationship between log-transformed LDH levels with AHF risk. Moreover, the weighted stratified analysis further suggested that the associations of log-transformed LDH with NAFLD and AHF could differ in different population groups.

CONCLUSIONS

This study indicates that elevated log-transformed LDH levels are associated with an increased prevalence of AHF in our study population. However, the cross-sectional study analysis cannot prove causality, which requires further cohort studies or mechanistic studies to elucidate the precise mechanisms and root causes.

摘要

背景

乳酸脱氢酶（LDH）与非酒精性脂肪性肝病（NAFLD）以及进展性肝纤维化（AHF）之间的关联尚未得到探究。本研究旨在调查对数转换后的LDH水平与NAFLD及AHF患病率之间的关联。

方法

在这项横断面研究中，应用特定的纳入和排除标准后，从59,842名参与者中选取了7316人进行最终分析。使用酶速率法测量LDH水平。发现脂肪肝指数（FLI）大于或等于60以及NAFLD纤维化评分（NFS）高于0.676表明存在肝脂肪变性和进展性肝纤维化。采用加权多变量线性和逻辑回归分析来完成本研究。此外，利用加权分层分析和使用广义相加模型（GAM）的加权平滑曲线拟合进行了额外分析。

结果

经过数据分析，多变量回归模型3显示对数转换后的LDH水平升高与AHF之间存在显著关联（比值比：3.087，95%置信区间：1.378 - 6.915，P = 0.007）。此外，观察到对数转换后的LDH三分位数与FLI之间存在适度关联（β = 0.965，95%置信区间：0.014 - 1.916，P = 0.047）。然而，在模型3中没有证据证明对数转换后的LDH水平与NAFLD之间存在关联。使用GAM的加权平滑曲线拟合表明对数转换后的LDH水平与NAFLD风险增加之间存在线性剂量反应效应，以及对数转换后的LDH水平与AHF风险之间存在非线性关系。此外，加权分层分析进一步表明对数转换后的LDH与NAFLD和AHF的关联在不同人群组中可能有所不同。