血清脂联素、视黄醇结合蛋白4及中性粒细胞/淋巴细胞比值对代谢相关脂肪性肝炎的诊断价值

魏燕娇; 雷俊杰; 郭剑津

doi:10.12449/JCH260913

血清脂联素、视黄醇结合蛋白4及中性粒细胞/淋巴细胞比值对代谢相关脂肪性肝炎的诊断价值

DOI: 10.12449/JCH260913

1.
山西医科大学第三医院（山西白求恩医院山西医学科学院同济山西医院）综合医疗科，太原 030032
2.
山西省汾阳医院放疗科，山西汾阳 032200

基金项目:

山西省基础研究计划项目 (202303021221198)

伦理学声明：本研究方案于2023年1月6日经由山西白求恩医院/山西医学科学院医学伦理委员会审批通过，伦理批号：YXLL-2023-011，所纳入患者均签署知情同意书。

利益冲突声明：本文不存在任何利益冲突。

作者贡献声明：魏燕娇负责课题设计，资料分析，撰写论文；魏燕娇、雷俊杰参与收集数据，修改论文；魏燕娇、郭剑津负责拟定写作思路，指导撰写文章并最后定稿。

详细信息

通信作者:
郭剑津， 15135184838@139.com （ORCID： 0009-0008-7473-1371）

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出版历程
- 收稿日期: 2026-02-10
- 录用日期: 2026-04-28
- 出版日期: 2026-09-25

Value of serum adiponectin, retinol-binding protein 4, and neutrophil-to-lymphocyte ratio in the diagnosis of metabolic dysfunction-associated steatohepatitis

1.
Department of General Medicine，The Third Hospital of Shanxi Medical University，Shanxi Bethune Hospital，Shanxi Academy of Medical Sciences，Tongji Shanxi Hospital，Taiyuan 030032，China
2.
Department of Radiation Oncology，Fenyang Hospital，Fenyang，Shanxi 032200，China

Research funding:

Shanxi Basic Research Project (202303021221198)

More Information

Corresponding author: Guo Jianjin， 15135184838@139.com （ORCID： 0009-0008-7473-1371）

摘要

摘要: 目的分析血清脂联素（ADPN）、视黄醇结合蛋白4（RBP4）及中性粒细胞/淋巴细胞比值（NLR）对代谢相关脂肪性肝炎（MASH）的评估价值，为临床预防提供参考。方法选取2023年1月—2025年1月于山西医科大学第三医院就诊的代谢相关脂肪性肝病（MAFLD）患者为研究对象，采用Logistic回归分析MASH的预测因素，采用R语言rms程序包建立列线图，绘制受试者操作特征曲线（ROC曲线）、校准曲线及决策曲线分析（DCA）评估模型的准确性和实用性，并采用Pearson相关性分析各指标间的相关性。计数资料两组间比较采用χ²检验；符合正态分布的计量资料两组间比较采用成组t检验；不符合正态分布的计量资料两组间比较采用Mann-Whitney U检验。结果共纳入298例MAFLD患者，其中MASH患者95例，单纯性脂肪变性患者203例。多因素Logistic回归分析显示，丙氨酸氨基转移酶（ALT）、碱性磷酸酶（ALP）、RBP4、ADPN及NLR是MASH的独立影响因素（P值均<0.05）。根据以上因素构建列线图模型并进行评估，ROC曲线结果显示，模型的曲线下面积为0.985（95%置信区间：0.976～0.995），灵敏度为0.968，特异度为0.901。校准曲线结果显示，H-L拟合优度检验（χ²=2.905，P=0.940）提示该模型预测概率与实际概率之间的差异无统计学意义，表明该模型拟合性良好、预测准确度较高。DCA结果显示，当预测风险阈值＞0.05时，该模型可获得净收益。Pearson相关性分析显示，MASH患者血清RBP4与ADPN呈负相关（r=-0.275，P<0.001），与NLR呈正相关（r=0.282，P<0.001）；ADPN与NLR呈负相关（r=-0.221，P<0.001）。结论 ALT、ALP、RBP4、ADPN及NLR是MASH发生的独立影响因素，临床应加强监测，早期识别高风险患者并及时干预，以降低其发病率及疾病进展风险。
- 代谢相关脂肪性肝炎 /
- 脂联素 /
- 视黄醇结合蛋白质类 /
- 中性粒细胞/淋巴细胞比值 /
- 危险因素 /
- 诊断
Abstract: Objective To investigate the value of serum adiponectin （ADPN）， retinol-binding protein 4 （RBP4）， and neutrophil-to-lymphocyte ratio （NLR） in assessing metabolic dysfunction-associated steatohepatitis （MASH）， and to provide a reference for clinical prevention. Methods A total of 298 patients with metabolic dysfunction-associated fatty liver disease （MAFLD） who attended The Third Hospital of Shanxi Medical University from January 2023 to January 2025 were enrolled as subjects. A Logistic regression analysis was used to investigate the predictive factors for MASH， and R language rms package was used to construct a nomogram. The receiver operating characteristic （ROC） curve， calibration curve， and decision curve analysis were used to evaluate model accuracy and practicality， and a Pearson correlation analysis was used to investigate the correlation between various indicators. The chi-square test was used for comparison of categorical data between groups； the independent-samples t test was used for comparison of normally distributed continuous data between groups， and the Mann-Whitney U test was used for comparison of non-normally distributed continuous data between groups. Results A total of 298 MAFLD patients were enrolled， among whom there were 95 patients with MASH and 203 patients with simple steatosis. The multivariate Logistic regression analysis showed that alanine aminotransferase （ALT）， alkaline phosphatase （ALP）， RBP4， ADPN， and NLR were independent influencing factors for MASH （all P<0.05）. A nomogram model was constructed based on the above factors， and the ROC curve analysis showed that the model had an area under the ROC curve of 0.985 （95% confidence interval： 0.976 — 0.995）， with a sensitivity of 0.968 and a specificity of 0.901. The calibration curve analysis showed no significant difference between the predicted and actual probabilities based on the Hosmer-Lemeshow goodness-of-fit test （χ²=2.905， P=0.940）， suggesting that the model had good fit and high predictive accuracy. The decision curve analysis showed that the model achieved net benefit when the risk threshold was >0.05. The Pearson correlation analysis showed that in MASH patients， serum RBP4 was negatively correlated with ADPN （r=-0.275， P<0.001） and was positively correlated with NLR （r=0.282， P<0.001）， and ADPN was negatively correlated with NLR （r=-0.221， P<0.001）. Conclusion ALT， ALP， RBP4， ADPN， and NLR are independent influencing factors for MASH. It is necessary in clinical practice to enhance monitoring， identify high-risk patients as early as possible， and provide timely intervention， so as to reduce the incidence rate of MASH and the risk of disease progression.
- Metabolic Dysfunction-Associated Steatohepatitis /
- Adiponectin /
- Retinol-Binding Proteins /
- Neutrophil-to-Lymphocyte Ratio /
- Risk Factors /
- Diagnosis

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注： ALT，丙氨酸氨基转移酶；ALP，碱性磷酸酶；ADPN，脂联素；RBP4，视黄醇结合蛋白4；NLR，中性粒细胞/淋巴细胞比值；MASH，代谢相关脂肪性肝炎。

图 1 MASH疾病预测模型的建立

Figure 1. Establishment of MASH disease prediction system

下载: 全尺寸图片幻灯片

注： a，ROC曲线；b，校准曲线；c，DCA曲线。ROC曲线，受试者操作特征曲线；DCA，决策曲线分析；MASH，代谢相关脂肪性肝炎；AUC，曲线下面积；CI，置信区间。

图 2 MASH疾病预测模型的评估

Figure 2. Evaluation of MASH disease prediction model

下载: 全尺寸图片幻灯片

注： a，RBP4与ADPN的相关性；b，RBP4与NLR的相关性；c，ADPN与NLR的相关性。ADPN，脂联素；RBP4，视黄醇结合蛋白4；NLR，中性粒细胞/淋巴细胞比值；MASH，代谢相关脂肪性肝炎。

图 3 MASH患者血清RBP4、ADPN、NLR相关性分析

Figure 3. Correlation analysis of serum RBP4， ADPN and NLR in MASH patients

下载: 全尺寸图片幻灯片

表 1 两组临床资料及实验室指标比较

Table 1. Comparison of clinical data and laboratory indicators between the two groups

因素	MASH组（n=95）	SFL组（n=203）	统计值	P值
性别［例（%）］			χ²=0.473	0.492
男	55（57.89）	126（62.07）
女	40（42.11）	77（37.93）
年龄（岁）	51.36±6.59	50.24±6.95	t=1.318	0.189
BMI（kg/m²）	26.86±4.21	24.93±4.07	t=3.773	<0.001
吸烟史［例（%）］			χ²=0.165	0.685
是	52（54.74）	106（52.22）
否	43（45.26）	97（47.78）
伴糖尿病［例（%）］			χ²=0.521	0.471
是	44（46.32）	85（41.87）
否	51（53.68）	118（58.13）
伴高血压［例（%）］			χ²=0.336	0.562
是	46（48.42）	91（44.83）
否	49（51.58）	112（55.17）
ALT（U/L）	45.23±11.57	30.31±9.68	t=11.633	<0.001
AST（U/L）	24.22±6.59	23.09±6.13	t=1.448	0.149
ALP（U/L）	101.39±12.27	82.37±10.43	t=13.850	<0.001
GGT（U/L）	63.58±11.23	66.16±12.65	t=1.699	0.090
TBil（μmol/L）	14.00（12.00～16.00）	14.00（12.00～16.00）	Z=-0.797	0.425
DBil（μmol/L）	5.00（4.00～7.00）	5.00（4.00～7.00）	Z=-0.368	0.713
TG（mmol/L）	3.45±1.10	3.21±0.95	t=1.931	0.055
TC（mmol/L）	5.23±0.98	5.18±0.99	t=0.408	0.684
HDL-C（mmol/L）	1.22±0.30	1.28±0.32	t=1.538	0.125
LDL-C（mmol/L）	3.84±0.91	3.63±0.91	t=1.856	0.064
ADPN（μg/mL）	9.13±2.05	11.58±2.43	t=8.510	<0.001
RBP4（mg/L）	25.00（22.00～27.00）	19.00（17.00～22.00）	Z=-10.625	<0.001
NLR	1.65±0.45	1.21±0.35	t=9.204	<0.001
PLT（×10⁹/L）	7.00（6.00～8.00）	7.00（6.00～8.00）	Z=-1.256	0.209
注：MASH，代谢相关脂肪性肝炎；SFL，单纯性脂肪变性；BMI，体重指数；ALT，丙氨酸氨基转移酶；AST，天冬氨酸氨基转移酶；ALP，碱性磷酸酶；GGT，γ-谷氨酰转移酶；TBil，总胆红素；DBil，直接胆红素；TG，甘油三酯；TC，总胆固醇；HDL-C，高密度脂蛋白胆固醇；LDL-C，低密度脂蛋白胆固醇；ADPN，脂联素；RBP4，视黄醇结合蛋白4；NLR，中性粒细胞/淋巴细胞比值；PLT，血小板。

下载: 导出CSV

表 2 MASH预测指标的Logistic多因素分析

Table 2. Multi-factor analysis of MASH predictors

自变量	B值	SE	Wald	P值	OR	95%CI
BMI	0.005	0.067	0.005	0.945	0.995	0.873～1.135
ALT	0.112	0.031	13.295	<0.001	1.118	1.053～1.188
ALP	0.142	0.033	18.011	<0.001	1.152	1.079～1.230
ADPN	-0.550	0.146	14.181	<0.001	0.577	0.434～0.768
RBP4	0.502	0.108	21.752	<0.001	1.651	1.337～2.039
NLR	3.911	1.004	15.192	<0.001	49.971	6.991～357.209
常量	-28.798	5.246	30.134	0.002	<0.001	—
注：BMI，体重指数；ALT，丙氨酸氨基转移酶；ALP，碱性磷酸酶；ADPN，脂联素；RBP4，视黄醇结合蛋白4；NLR，中性粒细胞/淋巴细胞比值；MASH，代谢相关脂肪性肝炎；OR，比值比；CI，置信区间；SE，标准误。

下载: 导出CSV

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