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单核细胞/高密度脂蛋白胆固醇与非酒精性脂肪性肝病的相关性分析

王娟 王迎春 王春宇

引用本文:
Citation:

单核细胞/高密度脂蛋白胆固醇与非酒精性脂肪性肝病的相关性分析

DOI: 10.3969/j.issn.1001-5256.2021.05.031
基金项目: 

大连大学博士启动专项基金 (20181QL005)

利益冲突声明:本研究不存在研究者、伦理委员会成员、受试者监护人以及与公开研究成果有关的利益冲突。
作者贡献声明:王娟负责课题设计,资料分析,论文撰写;王春宇参与数据收集;王迎春修改论文及最后定稿。
详细信息
    作者简介:

    王娟(1993—),女,主要从事非酒精性脂肪肝及胃肠肝胆病相关的研究

    通信作者:

    王迎春,wych_1648@126.com

  • 中图分类号: R575.5

Association between monocyte-to-high-density lipoprotein cholesterol ratio and nonalcoholic fatty liver disease

  • 摘要:   目的  探讨单核细胞/高密度脂蛋白胆固醇(MHR)与非酒精性脂肪性肝病(NAFLD)的关系。  方法  选取2018年1月—2020年10月入住大连大学附属中山医院消化内科并经腹部CT诊断为NAFLD的208例患者作为NAFLD组,另选取同期210例健康体检人群设为对照组。所有受试者均行血常规、生化及腹部CT检查,计算血清MHR水平。另外,根据腹部CT的影像学结果,将NAFLD患者分为轻度NAFLD组(n=148)及中重度NAFLD组(n=60),观察不同程度NAFLD患者与对照组WBC及MHR等指标的差异。正态分布计量资料两组间比较采用独立样本t检验,多组间比较采用单因素方差分析。偏态分布计量资料两组间比较采用Mann-Whitney U秩和检验,多组间采用Kruskal-Wallis H检验。计数资料两组间比较采用四格表χ2检验,3组间比较采用R×C表χ2检验。MHR与各代谢指标及NAFLD严重程度间的相关性采用Spearman相关分析。绘制受试者工作特征曲线评估MHR对NAFLD的诊断价值。  结果  与对照组相比,NAFLD组中的体质量(t=-10.573, P < 0.001)、BMI(t=-13.112, P < 0.001)、吸烟史(χ2=14.667, P < 0.001)、WBC(t=-7.359, P < 0.001)、单核细胞(Z=-9.932, P < 0.001)、LDL-C(t=-3.394, P=0.001)、TG(Z=-11.737, P < 0.001)、CHO(t=-2.985, P=0.003)、空腹血糖(Z=-7.827, P < 0.001)、ALT(Z=-12.583, P < 0.001)、AST(Z=-9.514, P < 0.001) 水平均增加,而血清HDL-C(t=10.440, P < 0.001)水平下降;另外,MHR水平存在性别差异,男性明显高于女性,差异有统计学意义(P < 0.001)。与对照组及轻度NAFLD组相比,血清MHR水平在中重度NAFLD组中显著升高,差异有统计学意义(P值均 < 0.001)。相关分析结果提示血清MHR水平与HDL-C呈负相关(r=-0.565, P < 0.001),与吸烟史、体质量、BMI、WBC、单核细胞、TG、空腹血糖、ALT、AST呈正相关(r值分别为0.449、0.482、0.430、0.478、0.892、0.333、0.157、0.386、0.281,P值均 < 0.01)。同时,MHR水平与NAFLD严重程度呈正相关(r=0.629,P < 0.001)。ROC曲线表明MHR曲线下面积为0.846(95%CI:0.810~0.882,P < 0.001),敏感度和特异度分别为77.9%和74.3%。  结论  血清MHR水平与NAFLD相关,可作为评价NAFLD病情进展的一种预测指标。

     

  • 图  1  对照组与NAFLD组患者血清MHR的比较

    图  2  对照组与不同程度NAFLD组MHR水平的比较

    图  3  MHR水平在不同性别间比较

    图  4  MHR水平在不同亚组性别内比较

    图  5  MHR诊断NAFLD的ROC曲线

    表  1  对照组与NAFLD组患者一般情况的比较

    指标 对照组(n=210) NAFLD组(n=208) 统计值 P
    男/女(例) 95/115 114/94 χ2=3.828 >0.050
    年龄(岁) 52(44~61) 55(43~62) Z=-1.066 0.286
    吸烟[例(%)] 30(14.29) 62(29.81) χ2=14.667 < 0.001
    身高(cm) 167(162~172) 170(162~175) Z=-1.891 0.059
    体质量(kg) 64.64±10.83 77.80±14.35 t=-10.573 < 0.001
    BMI(kg/m2) 22.88±2.87 27.03±3.56 t=-13.112 < 0.001
    WBC(×109/L) 5.11±1.14 6.00±1.31 t=-7.359 < 0.001
    单核细胞(×109/L) 0.16(0.13~0.20) 0.23(0.20~0.30) Z=-9.932 < 0.001
    HDL-C(mmol/L) 1.45±0.30 1.18±0.22 t=10.440 < 0.001
    MHR 0.12(0.08~0.16) 0.20(0.16~0.25) Z=-12.233 < 0.001
    LDL-C(mmol/L) 2.88±0.68 3.13±0.78 t=-3.394 0.001
    TG(mmol/L) 1.15(0.87~1.44) 1.92(1.49~2.86) Z=-11.737 < 0.001
    CHO(mmol/L) 4.99±0.90 5.28±1.02 t=-2.985 0.003
    FBG(mmol/L) 4.88(4.55~5.21) 5.34(4.89~6.06) Z=-7.827 < 0.001
    ALT(U/L) 16.0(12.0~24.0) 36.0(25.0~54.5) Z=-12.583 < 0.001
    AST(U/L) 18.00(15.00~21.00) 24.00(18.00~30.75) Z=-9.514 < 0.001
    下载: 导出CSV

    表  2  对照组与不同程度NAFLD患者一般情况的比较

    指标 对照组(n=210) 轻度NAFLD组(n=148) 中重度NAFLD组(n=60) 统计值 P
    男/女(例) 95/115 75/73 39/21 χ2=7.332 0.026
    年龄(岁) 51.40±11.78 53.61±11.50 50.43±13.32 F=2.141 0.119
    吸烟[例(%)] 30(14.29) 36(24.32) 26(43.33) H=23.654 < 0.001
    身高(cm) 167.0(162.0~172.0) 169.0(161.3~175.0) 170.5(162.0~177.0) H=5.292 0.071
    体质量(kg) 64.64±10.83 76.67±12.84 80.60±17.36 F=58.503 < 0.001
    BMI(kg/m2) 22.88±2.87 26.81±3.18 27.58±4.35 F=129.920 < 0.001
    WBC(×109/L) 5.11±1.14 5.79±1.17 6.51±1.49 F=54.130 < 0.001
    单核细胞(×109/L) 0.16(0.13~0.20) 0.21(0.19~0.26) 0.30(0.22~0.35) H=115.697 < 0.001
    HDL-C(mmol/L) 1.45±0.30 1.21±0.23 1.13±0.19 F=88.936 < 0.001
    MHR 0.12(0.08~0.16) 0.19(0.15~0.22) 0.26(0.20~0.32) H=167.607 < 0.001
    LDL-C(mmol/L) 2.88±0.68 3.18±0.79 2.99±0.75 F=7.180 0.001
    TG(mmol/L) 1.15(0.87~1.44) 1.91(1.53~2.82) 1.96(1.45~3.11) H=137.865 < 0.001
    CHO(mmol/L) 4.99±0.90 5.33±0.99 5.14±1.11 F=5.278 0.005
    FBG(mmol/L) 4.88(4.55~5.21) 5.34(4.87~6.05) 5.35(4.94~6.06) H=61.521 < 0.001
    ALT(U/L) 16.00(12.00~24.00) 32.00(21.78~50.00) 46.00(32.35~60.75) H=167.151 < 0.001
    AST(U/L) 18.00(15.00~21.00) 23.00(17.25~29.00) 24.50(21.00~33.75) H=95.963 < 0.001
    下载: 导出CSV

    表  3  血清MHR水平与各变量的相关性

    变量 r P
    年龄 -0.094 0.054
    吸烟史 0.449 < 0.001
    体质量 0.482 < 0.001
    BMI 0.430 < 0.001
    WBC 0.478 < 0.001
    单核细胞 0.892 < 0.001
    HDL-C -0.565 < 0.001
    LDL-C 0.013 0.781
    TG 0.333 < 0.001
    CHO -0.071 0.145
    FBG 0.157 0.001
    ALT 0.386 < 0.001
    AST 0.281 < 0.001
    NAFLD严重性 0.629 < 0.001
    下载: 导出CSV
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  • 收稿日期:  2020-07-30
  • 录用日期:  2020-08-31
  • 出版日期:  2021-05-20
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