美国成年人非高密度脂蛋白胆固醇与高密度脂蛋白胆固醇比值(NHHR)与慢性肾脏病风险的关联

The Association between Non-High-Density Lipoprotein Cholesterol to High-Density Lipoprotein Cholesterol Ratio (NHHR) and Risk of Chronic Kidney Disease among U.S. Adults

摘要: 目的：作为一种新提出的脂质指标，非高密度脂蛋白胆固醇与高密度脂蛋白胆固醇比值(NHHR)在心血管风险评估和代谢疾病管理中显示出明显优势。然而，其与慢性肾脏疾病(CKD)的关系尚不清楚。本研究旨在探讨这一潜在关联。方法：利用2011至2014年全国健康与营养调查(NHANES)数据，开展了一项包含9420名参与者的横断面研究。采用多变量逻辑回归和限制性立方样条(RCS)模型分析NHHR与CKD之间的关联。同时进行亚组分析和敏感性分析，评估结果的稳健性。结果：当NHHR作为连续变量时，它与CKD风险的增加相关(风险比 = 1.06，95%置信区间：1.01~1.12，p = 0.030)。作为分类变量时，调整混杂因素后，NHHR与CKD风险没有明显线性趋势(p = 0.293)。然而，RCS模型显示两者之间存在J型非线性相关(总体p < 0.001；非线性p < 0.001)，并且在NHHR = 2.65时CKD风险最低。亚组分析和敏感性分析支持了该结果的稳健性。结论：NHHR水平升高与CKD风险进展呈正相关，其最佳阈值为2.65，对应疾病风险最低。这表明，NHHR可能作为预测CKD风险的有效脂质指标。

Abstract: Background and Objective: As a newly proposed lipid ratio index, the non-high-density lipoprotein cholesterol to high-density lipoprotein cholesterol ratio (NHHR) has demonstrated significant advantages in cardiovascular risk assessment and metabolic disease management. However, its relationship with chronic kidney disease (CKD) remains unclear. This study aimed to investigate this potential association. Methods: Utilizing data from the National Health and Nutrition Examination Survey (NHANES) spanning 2011 to 2014, we conducted a cross-sectional study consisting of 9,420 participants. Multivariate logistic regression and restricted cubic spline (RCS) models were employed to examine the association between NHHR and CKD. Subgroup analysis and sensitivity analysis were performed to evaluate the robustness of the results. Results: When NHHR was treated as a continuous variable, it was associated with an increased risk of CKD (OR = 1.06, 95% CI: 1.01~1.12, p = 0.030). As a categorical variable, NHHR showed no significant linear trend with CKD risk after adjusting for confounding variables (p for trend = 0.293). However, the RCS model revealed a J-shaped nonlinear correlation between them (p for overall < 0.001; p for nonlinear < 0.001), with the lowest CKD risk observed at NHHR = 2.65. Subgroup analysis confirmed the stability of these findings, and sensitivity analysis supported the robustness of this nonlinear relationship. Conclusions: Elevated NHHR levels are positively associated with CKD risk progression, with an optimal threshold of 2.65 corresponding to the nadir of disease risk. These findings suggest that NHHR may serve as a clinically useful lipid parameter for CKD risk prediction.