Liu Junxi, Qiao Qilin, Yang Mocun, Wang Xue, Zhou Boda
School of Clinical Medicine, Tsinghua University, Beijing, China.
The Second High School Attached to Beijing Normal University International Department, Beijing, China.
Medicine (Baltimore). 2025 Jul 25;104(30):e43457. doi: 10.1097/MD.0000000000043457.
The progression of nonalcoholic fatty liver disease may lead to liver fibrosis, with liver stiffness measurement (LSM) as an important noninvasive measurement for liver stiffness, indirectly reflecting the degree of liver fibrosis. C-reactive protein-to-lymphocyte ratio (CLR) is an important inflammatory marker which has potential diagnostic value in nonalcoholic fatty liver disease. This study investigates the association between the CLR and LSM. Utilizing data from the National Health and Nutrition Examination Survey 2017 to 2018, we included participants completed the liver transient elastography exam with complete CLR value. We excluded participants lacking ultrasound data on essential covariates. Our study implemented multi-model linear regression analysis, subgroup analysis, to investigate the independent relationship between CLR and LSM. We enrolled a total of 3399 participants (51.3% male and 48.7% female). Participants were divided into 2 groups based on LSM cutoff value of 12.5 kPa, indicating severe liver fibrosis or cirrhosis. We found after adjusting every potential covariates, CLR was significantly associated with LSM (odd ratios = 0.38, 95% confidence interval: 0.28-0.48, P < .001). Subgroup analysis suggested the relationship between CLR and LSM remained consistent, a significant interaction was noted between CLR and LSM accross different race groups. The restricted cubic spline model indicated a significant nonlinear relationship between CLR and LSM. In the adult population above 20 year old of National Health and Nutrition Examination Survey in U.S., lower CLR level was associated with higher prevalence of LSM above 12.5 kPa, which may be influenced by race. These findings indicate CLR as an independent protective factor for clinically significant liver fibrosis.
非酒精性脂肪性肝病的进展可能导致肝纤维化，肝脏硬度测量（LSM）作为一种重要的肝脏硬度非侵入性测量方法，可间接反映肝纤维化程度。C反应蛋白与淋巴细胞比值（CLR）是一种重要的炎症标志物，在非酒精性脂肪性肝病中具有潜在的诊断价值。本研究调查了CLR与LSM之间的关联。利用2017年至2018年美国国家健康与营养检查调查的数据，我们纳入了完成肝脏瞬时弹性成像检查且CLR值完整的参与者。我们排除了缺乏基本协变量超声数据的参与者。我们的研究采用多模型线性回归分析、亚组分析，以研究CLR与LSM之间的独立关系。我们共纳入了3399名参与者（男性占51.3%，女性占48.7%）。根据LSM临界值12.5 kPa将参与者分为两组，该临界值表明存在严重肝纤维化或肝硬化。我们发现，在调整了所有潜在协变量后，CLR与LSM显著相关（比值比=0.38，95%置信区间：0.28 - 0.48，P < 0.001）。亚组分析表明CLR与LSM之间的关系保持一致，不同种族组的CLR与LSM之间存在显著交互作用。受限立方样条模型表明CLR与LSM之间存在显著的非线性关系。在美国国家健康与营养检查调查中20岁以上的成年人群中，较低的CLR水平与LSM高于12.5 kPa的较高患病率相关，这可能受种族影响。这些发现表明CLR是临床显著肝纤维化的独立保护因素。
