【作者】 王昊；

【导师】 刘焕兵；

【作者基本信息】 南昌大学 ， 临床医学硕士（专业学位）， 2023， 硕士

【摘要】 目的:本研究的目的是评估血小板与淋巴细胞比值(PLR)、淋巴细胞与单核细胞比值(LMR)与代谢相关脂肪性肝病(MAFLD)肝纤维化严重程度的相关性。方法:回顾性收集2015年4月1日至2022年9月30日在南昌大学第一附属医院诊断为MAFLD的病例96例,另收集体检中心健康人群89例作为对照组,共185例纳入此研究中。通过血常规中淋巴细胞计数、单核细胞计数、血小板计数,计算PLR、LMR。首先比较非MAFLD组与MAFLD组一般临床资料之间的差异,再用NFS评分(非酒精性脂肪肝纤维化评分)对MAFLD组进行肝纤维化严重程度的分级,NFS≤-1.455定义为非进展期肝纤维化,NFS≥0.676定义为进展期肝纤维化。比较非进展期肝纤维化组(n=61)和进展期肝纤维化组(n=35)一般临床资料之间的差异,再分析PLR、LMR与MAFLD肝纤维化严重程度的相关性。通过用受试者工作特征(ROC)曲线分析PLR、LMR对MAFLD肝纤维化的预测效果。结果:1、MAFLD组与非MAFLD组两组比较,患有MAFLD的患者比未患有MAFLD的患者年龄更大,男性患病的比例大于女性。在人体测量参数方面,MAFLD组的血压、体重指数更高。对于血液学参数,MAFLD组单核细胞绝对值、丙氨酸氨基转移酶、天门冬氨酸氨基转移酶、γ-谷氨酰转移酶、碱性磷酸酶、空腹血糖、甘油三酯水平显著高于非MAFLD组,而白蛋白、总胆固醇、高密度脂蛋白胆固醇、PLR、LMR水平显著低于非MAFLD组(P<0.05)。两组间血小板、淋巴细胞绝对值、总胆红素、直接胆红素、低密度脂蛋白胆固醇无统计学意义(P>0.05)。2、非进展期肝纤维化组和进展期肝纤维化组两组在性别、体重指数、吸烟史、收缩压、单核细胞绝对值、天门冬氨酸氨基转移酶、总胆红素、直接胆红素、碱性磷酸酶、总胆固醇、γ-谷氨酰转移酶、高密度脂蛋白胆固醇方面无统计学意义(P>0.05),两组在年龄、舒张压、血小板计数、淋巴细胞绝对值、丙氨酸氨基转移酶、白蛋白、空腹血糖、甘油三酯、低密度脂蛋白胆固醇方面有统计学意义(P<0.05)。进展期肝纤维化组的PLR、LMR显著低于非进展期肝纤维化组,差异具有统计学意义(P<0.05)。3、调整混杂因素后,PLR、LMR是MAFLD肝纤维化的独立影响因素。其比值比分别为0.914(95%CI:0.846-0.989)、0.148(95%CI:0.023-0.935),说明PLR、LMR越低,肝纤维化严重程度越重可能性越大。4、Spearman相关分析中PLR、LMR与NFS具有负相关性(r_s=-0.447,P<0.001;r_s=-0.221,P=0.03),因此PLR、LMR与肝纤维化的严重程度具有负相关性。5、ROC曲线分析结果,PLR、LMR的ROC曲线下面积分别为0.735、0.724,95%可信区间分别为0.634-0.837,0.623-0.826,P值均小于0.001。PLR的最佳截断值为94.13912,敏感度为0.803,特异度为0.543,LMR的最佳截断值为4.441156,敏感度为0.574,特异度为0.829。结论:PLR、LMR对MAFLD肝纤维化有良好的预测效果。PLR、LMR与MAFLD肝纤维化严重程度呈负相关性。PLR、LMR是易获取的炎症标志物,与纤维化严重程度相关。这种简单的诊断方法在未来可能会广泛应用。更多还原

【Abstract】 objective:The objective of this study was to assess the association of platelet to lymphocyte ratio(PLR)and lymphocyte to monocyte ratio(LMR)with the severity of hepatic fibrosis in metabolic associated fatty liver disease(MAFLD).Methods: A total of 96 cases diagnosed with MAFLD in the First Affiliated Hospital of Nanchang University from April 1,2015 to September 30,2022 were retrospectively collected,and 89 healthy people in the physical examination center were also collected as the control group.A total of 185 cases were included in this study.PLR and LMR were calculated by lymphocyte count,monocyte count and platelet count in blood routine.First,the differences in general clinical data between the non-MAf LD group and the MAFLD group were compared,and then the severity of liver fibrosis in the MAFLD group was graded using NFS score(non-alcoholic fatty liver fibrosis score).NFS≤-1.455 was defined as non-advanced liver fibrosis,and NFS≥0.676 was defined as advanced liver fibrosis.The difference of general clinical data between the non-advanced hepatic fibrosis group(n=61)and the advanced hepatic fibrosis group(n=35)was compared,and the correlation between PLR,LMR and the severity of MAFLD hepatic fibrosis was analyzed.The predictive effect of PLR and LMR on liver fibrosis in MAFLD was analyzed by receiver operating characteristic(ROC)curve.Results:1.Compared between the MAFLD group and the non-MAf LD group,in terms of demographic parameters,patients with MAFLD were older than those without MAFLD,and the proportion of men with MAFLD was greater than that of women.In terms of anthropometric parameters,blood pressure and BMI were higher in the MAFLD group.In terms of hematological parameters,MAFLD group MNC,ALT,AST,γ-The levels of ggt,ALP,FBG,and TG were significantly higher in the non MAFLD group,while TC,ALB,HDL-c,PLR and LMR in MAFLD group were significantly lower than those in non-MAf LD group(P<0.05).There were no significant differences in PLT,LYM,TB,DBil and LDL-c between the two groups(P>0.05).2.There was no statistical significance in gender,BMI,smoking history,systolic blood pressure,MNC,AST,TB,DBil,gamma-ggt,ALP,TC,HDL-c between the non-advanced liver fibrosis group and the advanced liver fibrosis group(P>0.05).There were significant differences in age,diastolic blood pressure,PLT,LYM,ALT,ALB,FBG,TG and LDL-c between the two groups(P<0.05).The PLR and LMR of advanced hepatic fibrosis group were significantly lower than those of non-advanced hepatic fibrosis group,and the difference was statistically significant(P<0.05).3.After adjusting for confounding factors,PLR and LMR were independent influencing factors of liver fibrosis in MAFLD.The odds ratios were 0.914(95%CI :0.846-0.989)and 0.148(95%CI :0.023-0.935),respectively,indicating that the lower the PLR and LMR,the greater the likelihood of severe liver fibrosis.4.In Spearman correlation analysis,PLR,LMR were negatively correlated with NFS(rs=-0.447,P <0.001;rs =-0.221,P = 0.03),so PLR and LMR were negatively correlated with the severity of hepatic fibrosis.5.The ROC curve analysis results show that the areas under the ROC curves of PLR and LMR are 0.735 and 0.724,respectively,with 95% confidence intervals of0.634-0.837 and 0.623-0.826,respectively.The P-values are both less than 0.001.The best truncation value of PLR was 94.13912,sensitivity was 0.803,specificity was0.543,and the best truncation value of LMR was 4.441156,sensitivity was 0.574,specificity was 0.829.Conclusion:PLR and LMR have good predictive effect on liver fibrosis in MAFLD.PLR and LMR were negatively correlated with the severity of liver fibrosis in MAFLD.PLR and LMR are readily available markers of inflammation,which are correlated with the severity of fibrosis.This simple diagnostic method could be widely used in the future.更多还原