中性粒细胞/淋巴细胞比值对非酒精性脂肪肝的诊断和预测价值

The diagnostic and predictive value of neutrophil to lymphocyte ratio in nonalcoholic fatty liver disease

目的探讨中性粒细胞/淋巴细胞比值(NLR)对非酒精性脂肪肝(NAFLD)的诊断和预测价值。方法选取2007年6月至2009年12月在湖南省人民医院体检的3596例个体为研究对象。根据腹部彩超检查有无脂肪肝将研究对象分为NAFLD 1组(n=1202)和非NAFLD 1组(n=2394),非NAFLD 1组中有720例进行2年后随访,再次行腹部彩超根据有无脂肪肝分为NAFLD 2组(n=169)和非NAFLD 2组(n=551)。分别比较对应两组第一年体检时的临床资料,采用Logistic回归分析NAFLD的独立危险因素,采用受试者工作特征(ROC)曲线分析NLR对NAFLD的诊断价值,根据NLR四分位数分组计算NAFLD的发病率,预测NAFLD的患病风险。结果与非NAFLD 1组相比,NAFLD 1组NLR升高,差异有统计学意义(P<0.05);Logistic回归分析显示,体质量指数(BMI)、舒张压(DBP)、丙氨酸氨基转移酶(ALT)、三酰甘油(TG)、高密度脂蛋白胆固醇(HDL-C)、空腹血糖(FPG)、尿酸(UA)、NLR是发生NAFLD的独立危险因素;ROC曲线分析显示,NLR诊断NAFLD的曲线下面积为0.729,最佳诊断值为1.75,灵敏度为62.1%,特异度为79.3%。与非NAFLD 2组相比,NAFLD 2组NLR升高,差异有统计学意义(P<0.05);NLR根据四分位数分组,水平1、水平2、水平3、水平4各组中NAFLD所占的比例分别为14.2%、21.3%、27.8%、30.78%。水平4组NAFLD发病率高于水平1组,差异有统计学意义(P<0.05),水平4组发生NAFLD的OR值为1.744(95%CI 1.065~2.856;P<0.05)。结论NLR在NAFLD患者中显著增高,是其发病的独立危险因素,对NAFLD具有良好的诊断和预测价值。

Objective To investigate the diagnostic and predictive value of neutrophil to lymphocyte ratio(NLR)in nonalcoholic fatty liver disease(NAFLD).Methods A total of 3596 subjects who underwent physical examination in Hunan Provincial People's Hospital from June 2007 to December 2009 were selected as the research objects.The subjects were divided into NAFLD group 1(n=1202)and non NAFLD group 1(n=2394)according to the presence or absence of fatty liver examined by abdominal color Doppler ultrasound.720 cases in the non NAFLD group 1 were followed up after two years.The subjects were divided into NAFLD group 2(n=169)and non NAFLD group 2(n=551)according to the presence or absence of fatty liver.The clinical data of the corresponding two groups at the first year of physical examination were compared,the independent risk factors of NAFLD were analyzed by logistic regression,the diagnostic value of NLR for NAFLD was analyzed by receiver operating characteristic(ROC)curve,the incidence rate of NAFLD was calculated by grouping according to the NLR quartile,and the risk of NAFLD was predicted.Results Compared with non NAFLD 1 group,NLR of NAFLD 1 group was higher,the differences were statistically significant(P<0.05);Logistic regression analysis showed that body mass index(BMI),diastolic blood pressure(DBP),alanine aminotransferase(ALT),triglyceride(TG),high density lipoprotein cholesterol(HDL-C),fasting blood glucose(FPG),uric acid(UA)and NLR were independent risk factors for NAFLD;ROC curve analysis showed that the area under the curve of NLR for diagnosing NAFLD was 0.729,the optimal diagnostic value was 1.75,the sensitivity was 62.1%,and the specificity was 79.3%.Compared with non NAFLD 2 group,NLR of NAFLD 2 group was higher,the differences were statistically significant(P<0.05);NLR was grouped according to the quartile level,the proportion of NAFLD in level 1,level 2,level 3 and level 4 groups was 14.2%,21.3%,27.8% and 30.78% respectively.The incidence rate of NAFLD in level 4 group was significantly higher than that in level 1 group(P<0.05).The OR value of NAFLD in level 4 group was 1.744(95%CI 1.065-2.856,P<0.05).Conclusion NLR is significantly increased in NAFLD,which is an independent risk factor and has good diagnostic and predictive value for NAFLD.