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中华肥胖与代谢病电子杂志

中华肥胖与代谢病电子杂志 ›› 2026, Vol. 12 ›› Issue (01) : 1 -8. doi: 10.3877/cma.j.issn.2095-9605.2026.01.001

论著

基于NHANES数据库的淋巴细胞-高密度脂蛋白胆固醇比值和代谢功能障碍相关脂肪性肝病的关系和阈值效应研究
宋保华1,†(), 王斌1, 帅青青2, 张秀芝1   
  1. 1335200　鹰潭，余江区人民医院消化内科
    2335200　鹰潭，余江区中医院消化内科
  • 收稿日期:2026-01-21 出版日期:2026-02-28
  • 通信作者: 宋保华

Exploring the relationship and threshold effects of lymphocyte-to-high-density lipoprotein cholesterol ratio in metabolic dysfunction-associated steatotic liver disease

Baohua Song1,†(), Bin Wang1, Qingqing Shuai2, Xiuzhi Zhang1   

  1. 1Department of Gastroenterology, Yujiang District People's Hospital Yingtan City, Yingtan 335200, China
    2Department of Gastroenterology, Yujiang District Traditional Chinese Medicine Hospital Yingtan City, Yingtan 335200, China
  • Received:2026-01-21 Published:2026-02-28
  • Corresponding author: Baohua Song
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引用本文：

宋保华, 王斌, 帅青青, 张秀芝. 基于NHANES数据库的淋巴细胞-高密度脂蛋白胆固醇比值和代谢功能障碍相关脂肪性肝病的关系和阈值效应研究[J/OL]. 中华肥胖与代谢病电子杂志, 2026, 12(01): 1-8.

Baohua Song, Bin Wang, Qingqing Shuai, Xiuzhi Zhang. Exploring the relationship and threshold effects of lymphocyte-to-high-density lipoprotein cholesterol ratio in metabolic dysfunction-associated steatotic liver disease[J/OL]. Chinese Journal of Obesity and Metabolic Diseases(Electronic Edition), 2026, 12(01): 1-8.

目的

研究淋巴细胞与高密度脂蛋白胆固醇的比值（LHR）与代谢功能障碍相关脂肪性肝病（MASLD）之间的联系。

方法

本研究用美国国家健康与营养检查调查数据库的数据，选取并纳入3 863名成年参与者。判断参与者有没有患MASLD，遵循大家都认可的标准。用多因素逻辑回归模型分析LHR和MASLD患病风险的关联，还用限制性立方样条回归研究有没有非线性关系。做阈值效应分析找潜在转折点，同时对亚组差异做了评估，结果做多因素逻辑回归分析，同时校正年龄、性别、种族、社会经济因素、生活方式、合并症、人体测量学指标和肝酶血脂等指标。

结果

LHR每增加1个单位，MASLD患病风险上升33% （OR：1.33，95%CI：1.18~1.50，P<0.001）。限制性立方样条分析显示，LHR和MASLD风险有明显的非线性关联，非线性检验的P值为0.02，风险最低点在LHR等于1.62的时候。进行阈值效应分析确定关键拐点，得出这个拐点对应的LHR值是2.554。如果LHR小于2.554，每升1个单位，MASLD风险明显上升53.5% （OR：1.535，95%CI：1.270~1.856，P<0.001）；当LHR大于等于2.554时，二者关联没统计学意义（OR：1.105，95%CI：0.718~1.700，P=0.650）。亚组分析结果显示，在肥胖人群（BMI达到或超过30 kg/m2）和糖尿病患者中，LHR和MASLD的关联变弱，LHR和MASLD患病风险有非线性关联。

结论

本研究表明，LHR作为一种易获取的复合生物标志物，可有效预测MASLD风险，其在基层医疗和大规模人群筛查中具有重要应用价值。

关键词: 代谢功能障碍相关脂肪性肝病, 淋巴细胞, 高密度脂蛋白胆固醇, 美国国家健康与营养检查调查
Objective

To examine the association between the lymphocyte-to-high-density lipoprotein cholesterol ratio (LHR) and metabolic dysfunction-associated steatotic liver disease (MASLD).

Methods

This study used data from the National Health and Nutrition Examination Survey (NHANES) database, including 3,863 adult participants. MASLD was diagnosed using current common criteria. We used multivariable logistic regression models to examine the association between LHR and MASLD risk, while restricted cubic spline (RCS) regression was used to look for nonlinear relationships. We found threshold effects using segmented linear regression, and subgroup differences were checked.

Results

Multivariable logistic regression analysis showed that for each unit rise in LHR, the risk of MASLD went up 33% (OR=1.33, 95%CI: 1.18-1.50, P<0.001) after considering age, sex, race, socioeconomic factors, lifestyle, comorbidities, anthropometric indices, and liver enzyme/lipid profiles. RCS analysis showed a clear nonlinear link between LHR and MASLD risk (P=0.02), with the lowest risk seen at LHR=1.62. Threshold analysis found an inflection point at LHR=2.554. When LHR <2.554, each unit rise in LHR pushed up MASLD risk by 53.5% (OR=1.535, 95%CI: 1.270-1.856, P<0.001); but when LHR≥2.554, the link was not significant (OR=1.105, 95%CI: 0.718-1.700, P=0.650). Subgroup analysis showed that the link weakened and became non-significant in people with obesity (BMI≥30 kg/m2) or diabetes.

Conclusion

LHR has a nonlinear link with MASLD risk, which means it might work as a biomarker for checking MASLD risk, especially for people without severe metabolic dysfunction.

Key words: Metabolic Dysfunction-Associated Steatotic Liver Disease (MASLD), Lymphocyte, High-Density Lipoprotein Cholesterol, NHANES
图1 研究对象流程图注：2017-2018年国家健康与营养调查研究参与者筛选流程图。NHANES：国家健康与营养调查；LHR：淋巴细胞与高密度脂蛋白胆固醇比值；CAP：受控衰减参数
表1 研究对象基线特征
协变量 Total (n=3 863) Q1 (n= 955) Q2 (n= 953) Q3 (n=957) Q4 (n=958) P值
年龄（岁, ±s) 50.7±17.3 55.8±17.3 50.4±17.4 49.2±16.9 47.4±16.4 <0.001
家庭收入贫困比(±s) 2.6±1.6 2.7±1.6 2.7±1.6 2.5±1.6 2.4±1.6 <0.001
谷丙转氨酶[U/L, M(IQR)] 18.0 (13.0, 26.0) 16.0 (13.0, 22.0) 17.0 (13.0, 24.0) 19.0 (14.0, 27.0) 21.0 (15.0, 32.0) <0.001
谷草转氨酶(U/L, ±s) 22.0±12.6 22.8±16.0 21.3±10.2 21.3±10.1 22.8±13.0 0.003
总胆固醇(mmol/L, ±s) 4.9±1.0 4.9±1.1 4.8±1.0 4.9±1.1 4.9±1.1 0.161
甘油三酯(mmol/L, M(IQR)] 1.3 (0.9, 1.9) 1.0 (0.7, 1.3) 1.2 (0.9, 1.6) 1.5 (1.1, 2.1) 1.9 (1.3, 2.7) <0.001
体重指数(kg/m2, ±s) 29.7±7.1 27.1±6.3 28.6±6.7 30.7±7.1 32.3±7.2 <0.001
腰围(cm, ±s) 100.6±16.9 94.5±15.8 97.7±16.1 103.3±16.8 106.8±16.2 <0.001
性别[例(%)]           <0.001
男 1879 (49.1) 394 (41.3) 432 (45.3) 511 (53.4) 542 (56.6)  
女 1944 (50.9) 561 (58.7) 521 (54.7) 446 (46.6) 416 (43.4)  
吸烟状况[例(%)]           <0.001
是 1622 (42.4) 387 (40.5) 349 (36.6) 405 (42.3) 481 (50.2)  
否 2201 (57.6) 568 (59.5) 604 (63.4) 552 (57.7) 477 (49.8)  
糖尿病状态[例(%)]           0.004
否 3246 (84.9) 828 (86.7) 818 (85.8) 821 (85.8) 779 (81.3)  
是 577 (15.1) 127 (13.3) 135 (14.2) 136 (14.2) 179 (18.7)  
婚姻状况[例(%)]           0.067
否 1017 (26.6) 224 (23.5) 257 (27.0) 262 (27.4) 274 (28.6)  
是 2806 (73.4) 731 (76.5) 696 (73.0) 695 (72.6) 684 (71.4)  
教育水平[例(%)]           <0.001
高中以下学历 693 (18.1) 151 (15.8) 164 (17.2) 168 (17.6) 210 (21.9)  
高中或同等学力 918 (24.0) 203 (21.3) 217 (22.8) 243 (25.4) 255 (26.6)  
大学本科及以上学历 2212 (57.9) 601 (62.9) 572 (60.0) 546 (57.1) 493 (51.5)  
种族[例(%)]           <0.001
墨西哥裔美国人 502 (13.1) 75 (7.9) 135 (14.2) 122 (12.7) 170 (17.7)  
其他西班牙裔 339 (8.9) 68 (7.1) 90 (9.4) 84 (8.8) 97 (10.1)  
非西班牙裔白人 1399 (36.6) 382 (40) 328 (34.4) 364 (38.0) 325 (33.9)  
非西班牙裔黑人 837 (21.9) 261 (27.3) 211 (22.1) 185 (19.3) 180 (18.8)  
其他种族 746 (19.5) 169 (17.7) 189 (19.8) 202 (21.1) 186 (19.4)  
表2 多因素Logistic回归分析结果
Variable n.total n.event_% Crude model Model 1 Model 2
OR (95%CI) P值 OR (95%CI) P值 OR (95%CI) P值
LHR 3 863 1 793 (46.4) 2.04 (1.86~2.23) <0.001 2.19 (1.99~2.41) <0.001 1.33 (1.18~1.5) <0.001
LHR(quartile)                
Q1 955 290 (30.4) 1 (Ref)   1 (Ref)   1 (Ref)  
Q2 953 352 (36.9) 1.34 (1.11~1.63) 0.002 1.47 (1.21~1.79) <0.001 1.06 (0.84~1.34) 0.603
Q3 957 523 (54.6) 2.76 (2.29~3.33) <0.001 3.21 (2.63~3.91) <0.001 1.74 (1.37~2.2) <0.001
Q4 958 608 (63.5) 3.98 (3.29~4.82) <0.001 4.74 (3.86~5.81) <0.001 1.78 (1.38~2.31) <0.001
Trend.test       <0.001   <0.001   <0.001
图2 Logistic回归分析的非线性关联结果
表3 阈值效应分析结果
Item n Breakpoint/OR (95%CI) P值
Estimate_Breakpoint_1 3 803 2.554 (2.499, 2.61) NA
Effect_Size_1 3 242 1.535 (1.27~1.856) <0.001
Effect_Size_2 561 1.105 (0.718~1.7) 0.650
Likelihood Ratio test - - 0.088
图3 森林图结果
表4 亚组分析结果
亚组 n.total n.event_% crude.OR_95CI crude.P_value adj.OR_95CI adj.P_value P.for.interaction_1
性别             0.687
男 1 899 975 (51.3) 1.95 (1.72~2.2) <0.001 1.21 (1.03~1.42) 0.018  
女 1 964 818 (41.6) 2.06 (1.81~2.34) <0.001 1.22 (1.03~1.44) 0.018  
年龄（岁）             0.71
<40 1 127 375 (33.3) 2.67 (2.24~3.18) <0.001 1.3 (1.02~1.65) 0.033  
40~59 1 258 657 (52.2) 2.19 (1.86~2.58) <0.001 1.32 (1.08~1.62) 0.008  
≥60 1 478 761 (51.5) 2.01 (1.73~2.35) <0.001 1.32 (1.1~1.59) 0.003  
体重指数(kg/m2)             0.126
<25 999 142 (14.2) 1.82 (1.4~2.35) <0.001 1.3 (0.92~1.83) 0.133  
25~29.9 1 233 525 (42.6) 1.71 (1.47~1.98) <0.001 1.41 (1.17~1.70) <0.001  
≥30 1 631 1 126 (69.0) 1.48 (1.29~1.70) <0.001 1.04 (0.89~1.22) 0.627  
糖尿病状态             0.059
无 3 275 1 386 (42.3) 2.1 (1.91~2.32) <0.001 1.31 (1.15~1.48) <0.001  
有 588 407 (69.2) 1.59 (1.26~2.01) <0.001 1 (0.76~1.33) 0.979  
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