Clinical Value Of Serum TSH And NLR In NAFLD

【Objective】In patients with nonalcoholic fatty liver disease(NAFLD)diagnosed by liver biopsy,the differences of thyroid related hormones and neutrophil to lymphocyte ratio(NLR)in different liver pathological groups were compared,and the relationship between thyroid stimulating hormone(TSH),NLR and liver histopathological characteristics was discussed.Besides,the diagnostic efficacy of TSH and NLR in nonalcoholic steatohepatitis(NASH)and liver fibrosis was analyzed,and the equation prediction model including biomarkers such as TSH and NLR was explored.【Methods】Patients with NAFLD confirmed by liver biopsy in our hospital from July 2012 to February 2019 were selected as the subjects of study.All subjects were divided into NASH group and non-NASH group,no/mild fibrosis group(F0-1)and significant fibrosis group(F2-4).The differences of thyroid related hormones and NLR in NASH and non-NASH group,and fibrosis stage F0-1 and F2-4 group were compared respectively.For the TSH levels,we conducted further analysis based on gender subgroup.Also,we further discussed the correlation between TSH,NLR and the components of liver histopathological characteristics.In addition,we analyzed the predictive efficiency of TSH and NLR on NASH and fibrosis by receiver operating characteristic curve(ROC curve).We constructed the equation prediction model of NASH and fibrosis by multiple logistic regression analysis,and analyzed the predictive efficiency of the model by ROC curve.SPSS 22 and Graph Pad Prism 6 statistical software were used for statistical analysis.Multiple regression analysis was performed using Logistic.ROC curve analysis and Youden index were used to evaluate the predictive efficiency of TSH,NLR and the established prediction model for NAFLD disease progression.【Results】1.The serum TSH and NLR levels in NASH patients were significantly higher than those in non-NASH patients,but there was no significant difference in serum free triiodothyronine(FT3)and free thyroxine(FT4)levels between the two groups.In the gender-based subgroup analysis,the differences of serum TSH levels between the two groups were still statistically significant(all P<0.05).2.The serum TSH levels and NLR in significant fibrosis group(F2-4)were higher than those in non/mild liver fibrosis group(F0-1),and the differences were statistically significant(all P<0.05),but there was no significant difference in serum FT3 and FT4 levels between the two groups(all P>0.05).In addition,in the gender-based subgroup analysis,the differences of serum TSH level between the two groups were still statistically significant(all P<0.05).3.The results of Spearman correlation analysis showed that serum TSH levels were positively correlated with body mass index(BMI),hepatocyte steatosis,lobular inflammation,ballooning degeneration,NAFLD activity score(NAS)and hepatic fibrosis stage(all P<0.05).Also,the NLR value was positively correlated with age,hepatocyte steatosis,lobular inflammation,ballooning degeneration,NAS and liver fibrosis stage(all P<0.05).4.A single TSH and NLR are not enough to predict NASH and the degree of fibrosis.After establishing the equation models in conjunction with other laboratory indexes,the prediction efficiency of the model for NASH and significant fibrosis is significantly improved.The area under the curve of the NASH equation model is 0.84(0.77-0.90).When the diagnostic cut-off value of the equation is 0.49,the sensitivity for predicting the NASH occurrence is 82%,and the specificity is 77%.The area under the curve of the fibrosis equation model is 0.79(0.71-0.87).When the diagnostic cut-off value of the equation is 0.56,the sensitivity for predicting significant fibrosis is 71%,and the specificity is 73%.【Conclusions】1.In this study,we found that serum TSH level and NLR were closely related to the severity of NAFLD,suggesting that this simple and easily available laboratory index may be incorporated into the future non-invasive diagnostic scoring model to predict the occurrence of NASH and the degree of fibrosis.2.The equation prediction model constructed by TSH and NLR combined with other laboratory indexes can significantly improve the efficacy of diagnosis of NASH and significant fibrosis.Because of its non-invasive,convenience and repeatability,it can be used to screen the severe NAFLD patients.