单核细胞与高密度脂蛋白胆固醇比值对社区居民非酒精性脂肪性肝病合并代谢综合征的预测价值及多因素Logistic决策树分析  

Predictive Value of Monocyte to High-density Lipoprotein Cholesterol Ratio for Nonalcoholic Fatty Liver Disease Merged with Metabolic Syndrome in Community Residents and Associated Factors Assessed Using Multivariate Regression Tree Analysis

作　　者：马纪林 张雪平 MA Jilin;ZHANG Xueping(Songjiang District Sijing Community Health Center,Shanghai 201601,China)

机构地区：[1]上海市松江区泗泾镇社区卫生服务中心,201601

出　　处：《中国全科医学》2022年第17期2126-2134,共9页Chinese General Practice

摘　　要：背景非酒精性脂肪性肝病(NAFLD)早期难以发现,常在出现代谢性疾病时才能被发现,但目前关于非侵入性指标对NAFLD合并代谢综合征预测价值的研究报道较少见。目的探讨非侵入性指标单核细胞与高密度脂蛋白胆固醇比值(MHR)对NAFLD合并代谢综合征的预测价值,并进行多因素Logistic决策树分析。方法2020年6—12月,共有9812例年龄>45周岁的社区常住居民在上海市松江区泗泾镇社区卫生服务中心进行健康体检,其中符合纳入与排除标准的目标代谢性疾病(包括代谢综合征、糖尿病、高血压、血脂异常等)患者4652例,无代谢性疾病患者1075例(健康对照组);4652例目标代谢性疾病患者中无NAFLD及代谢综合征者1948例(对照组),仅有NAFLD者1248例(NAFLD组),NAFLD合并代谢综合征者1456例(MAFLD组)。比较四组受试者一般资料、人体测量学指标、血压、生化指标及血常规检查结果;MHR、脂质蓄积指数(LAP)与分组的相关性分析采用Spearman秩相关分析。绘制受试者工作特征(ROC)曲线以确定非侵入性指标中性粒细胞与淋巴细胞比值(NLR)、血小板与淋巴细胞比值(PLR)、淋巴细胞与单核细胞比值(LMR)、MHR预测社区居民NAFLD合并代谢综合征的最佳截断值,并进行多因素Logistic决策树分析。结果本研究在9812例进行健康体检的年龄>45周岁的社区常住居民中共发现目标代谢性疾病患者7517例、NAFLD患者2704例,目标代谢性疾病、NAFLD患病率分别为76.61%(7517/9812)、27.59%(2704/9812)。四组受试者女性比例、年龄、体质指数(BMI)、腰围、臀围、腰臀比、收缩压、舒张压、空腹血糖、总胆固醇、三酰甘油、低密度脂蛋白胆固醇(LDL-C)、高密度脂蛋白胆固醇(HDL-C)、总胆红素、血尿酸、丙氨酸氨基转移酶(ALT)、天冬氨酸氨基转移酶(AST)、ALT/AST、γ-谷氨酰转肽酶(GGT)、估算肾小球滤过率(eGFR)、白细胞计数、中性粒细胞计数、单�Background Nonalcoholic fatty liver disease(NAFLD)is rarely detected at early stage,and often found when merged with metabolic disorders.Currently,the predictive value of noninvasive indicators for NAFLD with metabolic syndrome(MS)has been rarely reported.Objective To assess the predictive value of monocyte to high-density lipoprotein cholesterol ratio(MHR)for NAFLD with MS in community residents,and to evaluate the associated factors using multivariate regression tree analysis.Methods From June to December 2020,among 9812 permanent community residents(>45 years)who underwent physical examination in Songjiang District Sijing Community Health Center,5727 eligible individuals were selected,including 4652 with MS,diabetes,hypertension and dyslipidemia and other metabolic disorders〔1948 with no NAFLD and MS(controls),1248 with NAFLD(NAFLD cases),1456 with both NAFLD and MS(MAFLD cases)〕,and 1075 without metabolic disorders(healthy controls).General data,anthropometric parameters,blood pressure,biochemical parameters and routine blood test results of all participants were collected.Spearman rank correlation analysis was performed to assess the correlation of MHR and lipid accumulation product(LAP)index with NAFLD and MS.ROC analysis was conducted to analyze the optimal cutoff value of noninvasive indicators〔including neutrophil to lymphocyte ratio(NLR),platelet to lymphocyte ratio(PLR),lymphocyte to monocyte ratio(LMR)and MHR〕for NAFLD with MS.Factors associated with the predictive value of above-mentioned noninvasive indicators for NAFLD with MS were identified using multivariate regression tree analysis.Results The prevalence rates for metabolic disorders and NAFLD in this group were 76.61%(7517/9812)and 27.59%(2704/9812),respectively.The controls,NAFLD cases,MAFLD cases,and healthy controls had significant differences in female ratio,mean age,BMI,waistline,hipline,waist-to-hip ratio,systolic and diastolic blood pressure,fasting blood glucose,total cholesterol,triacylglycerol,low-density lipoprotein choleste

关 键 词：非酒精性脂肪性肝病 代谢综合征 性别因素 人体质量指数 血糖 单核细胞 胆固醇 HDL 

分 类 号：R575.5[医药卫生—消化系统] R589[医药卫生—内科学]