Page 82 - 中国全科医学2022-17

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马纪林，张雪平 . 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［J］. 中国全科医学，2022，25（17）：2126-2134.［www.chinagp.net］
MA J L，ZHANG X P. 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［J］. Chinese General Practice，2022，25（17）：2126-2134.

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 MA Jilin ，ZHANG Xueping
Songjiang District Sijing Community Health Center，Shanghai 201601，China
*
Corresponding author：MA Jilin，Associate chief physician；E-mail：sijinshihua@163.com
【Abstract】 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 9 812 permanent community residents（>45 years）
who underwent physical examination in Songjiang District Sijing Community Health Center，5 727 eligible individuals were
selected，including 4 652 with MS，diabetes，hypertension and dyslipidemia and other metabolic disorders〔1 948 with no
NAFLD and MS（controls），1 248 with NAFLD（NAFLD cases），1 456 with both NAFLD and MS（MAFLD cases）〕，
and 1 075 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%
（7 517/9 812）and 27.59%（2 704/9 812），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 cholesterol，HDL-C，
total bilirubin， serum uric acid，ALT，AST，ALT/AST ratio，GGT，eGFR，white blood cell count，neutrophil count，
monocyte count，lymphocyte count，platelet count，NLR，PLR，LMR，MHR，alcoholic fatty liver disease to NAFLD index，
LAP index，and atherogenic index of plasma，and distribution of waistline and BMI，as well as prevalence of hypertension and
dyslipidemia（P<0.01）. Spearman rank correlation analysis showed that，MHR was positively correlated with the grouping（r s =0.342，
P<0.001）；LAP index was also positively correlated with the grouping（r s =0.580，P<0.001）. ROC analysis found that，in the
prediction of NAFLD with MS，the AUC of NLR was 0.528〔95%CI（0.511，0.545）〕with 74.66% sensitivity，and 31.52%
specificity when the optimal cutoff value was chosen as 2.192，that of PLR was 0.581〔95%CI（0.564，0.598）〕with 59.82%
sensitivity，and 53.95% specificity when the optimal cut-off value was chosen as 115.470，and that of LMR was 0.546〔95%CI
（0.529，0.563）〕with 51.79% sensitivity，and 56.62% specificity when the optimal cut-off value was chosen as 0.193，and
that of MHR was 0.695〔95%CI（0.679，0.711）〕with 69.51% sensitivity，and 60.63% specificity when the optimal cut-
off value was chosen as 0.292. Multivariate regression tree analysis revealed that sex，BMI，waistline， triacylglycerol，and
fasting blood glucose were associated with the predictive value of MHR for NAFLD with MS. Conclusion The value of MHR for
predicting NAFLD with MS in physical examinees in the community is relatively high，but it may be significantly influenced by
sex，BMI，waistline，triacylglycerol and fasting blood glucose.
【Key words】 Non-alcoholic fatty liver disease；Metabolic syndrome；Sex factors；Body mass index；Blood
glucose；Monocytes；Cholesterol，HDL

非 酒 精 性 脂 肪 性 肝 病（non-alcoholic fatty liver 学特征，如开始阶段简单的肝硬化，其组织病理学特征
disease，NAFLD）是一组以肝细胞中脂质积累过多为特 是脂肪液滴在肝细胞中积累，而这通常是良性和无症状
征的疾病。NAFLD 的每个阶段均具有鲜明的组织病理 的；开始阶段简单的肝硬化可能进一步发展为非酒精性