中性粒淋巴细胞比值与成年人听力损失及听力阈值的关系: 基于NHANES数据库的横断面研究

Correlation between neutrophil-to-lymphocyte ratio with hearing loss and audiometric thresholds in adults: a cross-sectional study based on NHANES

摘要

目的 基于美国国家健康与营养调查2005-2010年及2015-2018年五个周期的数据，探究中性粒淋巴细胞比值(neutrophil lymphocyte ratio, NLR)与成年人听力损失及低频、言语和高频纯音测听平均阈值(pure tone average, PTA)的相关性。方法 采用横断面研究设计，纳入符合标准的成年人群数据。采用多元Logistic回归分析评估NLR与听力损失的相关性，多元线性回归分析评估NLR与低频、言语及高频PTA的相关性。采用平滑曲线拟合探究NLR与听力损失和低频、言语及高频PTA之间的分段线性关系，并通过阈值效应分析确定拐点值。结果 研究共纳入5004例样本量。调整混杂变量后，NLR每升高1个单位，听力损失的患病率增加11%(OR=1.11，95%CI:1.02~1.21)，差异具有统计学意义。NLR与低频，言语及高频PTA均呈正相关(β=0.78 dB、0.83 dB、1.00 dB)，差异均具有统计学意义。平滑曲线拟合和阈值效应分析显示，NLR与低频及言语PTA存在分段线性关系，拐点位于4.19。当NLR<4.19时NLR与低频及言语PTA呈正相关(β=1.15 dB、1.16 dB)，差异具有统计学意义；当NLR≥4.19时，差异无统计学意义。结论 NLR升高与成年人听力损失患病率增加及听阈阈值升高相关，提示炎症反应可能在听力损伤病理过程中起重要作用，NLR作为评估听力损失风险的潜在生物标志物具有探索价值，值得临床研究进一步验证。

Abstract

Objective To investigate the association between the neutrophil-to-lymphocyte ratio (NLR) and hearing loss, as well as the average thresholds of low-, speech-and high-frequency pure-tone average (PTA), in adults. It is based on data from the National Health and Nutrition Examination Survey from 2005-2010 and 2015-2018. Methods A cross-sectional study design was adopted to include data from the eligible adult population. Multiple logistic regression analysis was employed to evaluate the association between NLR and hearing loss. Multiple linear regression analysis was used to evaluate the association between NLR and low-frequency, speech-and high-frequency PTA. Smoothing curve fitting was employed to investigate the piecewise linear relationship between NLR and hearing loss, as well as low-frequency, speech and high-frequency PTA. Threshold effect analysis was then used to determine the inflection point. Results The analysis included 5,004 participants. After adjusting for confounding variables, the prevalence of hearing loss increased by 11% (OR=1.11, 95%CI: 1.02-1.21) for every one-unit increase in NLR, and this difference was statistically significant. NLR was positively correlated with low-frequency, speech, and high-frequency PTA (β=0.78 dB, 0.83 dB, 1.00 dB), and these differences were statistically significant. Smooth curve fitting and threshold effect analysis revealed a piecewise linear relationship between NLR and low-frequency and speech PTA, with an inflection point at 4.19. When NLR< 4.19, NLR was positively correlated with low-frequency and speech PTA (β =1.15 dB, 1.16 dB), and the difference was statistically significant. When NLR ≥4.19, however, the difference was not statistically significant. Conclusion An increased NLR is associated with an increased prevalence of hearing loss and a higher hearing threshold in adults. This suggests that the inflammatory response may play an important role in the pathological process of hearing loss. As a potential biomarker for assessing risk, the NLR is exploratory and worthy of further verification in clinical studies.

关键词

中性粒淋巴细胞比值 / 听力损失 / 美国国家健康与营养调查数据库 / 横断面研究

Key words

Neutrophil lymphocyte ratio / Hearing loss / NHANES / Cross-sectional study

参考文献

[1] Chadha S , Kamenov K , Cieza A . The world report on hearing, 2021[J]. Bull World Health Organ, 2021, 99(4): 242-242A. doi: 10.2471/blt.21.285643

[2] Gregory GE , Munro KJ , Couper KN , et al. The NLRP3 inflammasome as a target for sensorineural hearing loss[J]. Clin Immunol, 2023, 249: 109287. doi: 10.1016/j.clim.2023.109287

[3] Buonacera A , Stancanelli B , Colaci M , et al. Neutrophil to lymphocyte ratio: an emerging marker of the relationships between the immune system and diseases[J]. Int J Mol Sci, 2022, 23(7): 3636. doi: 10.3390/ijms23073636

[4] Sehgal SA , Malik G , Sachdeva A , et al. Pretreatment neutrophil-lymphocyte ratio (NLR): a felicitous prognostic marker in carcinoma lung[J]. J Cancer Res Ther, 2023, 19(2): 719-723. doi: 10.4103/jcrt.jcrt_688_22

[5] Zhou EY , Wu J , Zhou X , et al. The neutrophil-lymphocyte ratio predicts all-cause and cardiovascular mortality among U.S. adults with rheumatoid arthritis: results from NHANES 1999-2020[J]. Front Immunol, 2023, 14: 1309835. doi: 10.3389/fimmu.2023.1309835

[6] 谢晓彤, 刘婧禹, 马壬杰, 等 . 食管鳞癌患者新辅助治疗后的中性粒细胞/淋巴细胞比值与病理反应的相关性[J]. 临床肿瘤学杂志, 2025, 30(2): 138-142. doi: 10.3969/j.issn.1009-0460.2025.02.006

[7] XIE Xiaotong , LIU Jingyu , MA Renjie , et al. Correlation between neutrophil-lymphocyte ratio and pathological response after neoadjuvant treatment for patients with esophageal squamous cell carcinoma[J]. Chinese Clinical Oncology, 2025, 30(2): 138-142. doi: 10.3969/j.issn.1009-0460.2025.02.006

[8] 孙沁瑜, 邓毅凡, 何胜虎, 等 . 中性粒细胞/淋巴细胞比值、单核细胞/高密度脂蛋白胆固醇比值及两者联合对急性ST段抬高型心肌梗死患者急诊经皮冠状动脉介入治疗术后造影剂肾病的预测价值研究[J]. 中国全科医学, 2025, 28(15): 1891-1897. doi: 10.12114/j.issn.1007-9572.2024.0462

[9] SUN Qinyu , DENG Yifan , HE Shenghu , et al. Study of the predictive value of neutrophil/lymphocyte ratio, monocyte/high-density lipoprotein cholesterol ratio, and the combination of the two for contrast nephropathy after emergency PCI in patients with acute ST-segment elevation myocardial infarction[J]. Chinese General Practice, 2025, 28(15): 1891-1897. doi: 10.12114/j.issn.1007-9572.2024.0462

[10] 宋少鹏, 李进兴, 李文文, 等 . 中性粒细胞淋巴细胞比值和血小板淋巴细胞比值与突发性聋相关性的研究[J]. 临床耳鼻咽喉头颈外科杂志, 2018, 32(19): 1486-1490. doi: 10.13201/j.issn.1001-1781.2018.19.011

[11] SONG Shaopeng , LI Jinxing , LI Wenwen , et al. Study on the relationship between neutrophil lymphocyte ratio and platelet lymphocyte ratio and sudden deafness[J]. Journal of Clinical Otorhinolaryngology Head and Neck Surgery, 2018, 32(19): 1486-1490. doi: 10.13201/j.issn.1001-1781.2018.19.011

[12] 陈一博, 安云芳, 赵长青, 等 . 突发性聋患者中性粒细胞与淋巴细胞比值的特点及临床意义[J]. 临床耳鼻咽喉头颈外科杂志, 2025, 39(1): 34-41. doi: 10.13201/j.issn.2096-7993.2025.01.008

[13] CHEN Yibo , AN Yunfang , ZHAO Changqing , et al. Characteristics and clinical significance of neutrophil to lymphocyte ratio in patients with sudden sensorineural hearing loss[J]. Journal of Clinical Otorhinolaryngology Head and Neck Surgery, 2025, 39(1): 34-41. doi: 10.13201/j.issn.2096-7993.2025.01.008

[14] 陈博文, 刘迎新, 金永德, 等 . 中性粒细胞计数、中性粒细胞与淋巴细胞比值对突发性聋预后的影响[J]. 延边大学医学学报, 2020, 43(1): 32-37. doi: 10.16068/j.1000-1824.2020.01.008

[15] CHEN Bowen , LIU Yingxin , JIN Yongde , et al. Effects of neutrophil count, neutrophil to lymphocyte ratio on the prognosis of sudden deafness[J]. Journal of Medical Science Yanbian University, 2020, 43(1): 32-37. doi: 10.16068/j.1000-1824.2020.01.008

[16] Zhou ZM , Han YY . Association between oxidative balance score and hearing loss: a cross-sectional study from the NHANES database[J]. Front Nutr, 2024, 11: 1375545. doi: 10.3389/fnut.2024.1375545

[17] Wang YX , Liu H , Nie XL , et al. L-shaped association of triglyceride glucose index and sensorineural hearing loss: results from a cross-sectional study and Mendelian randomization analysis[J]. Front Endocrinol (Lausanne), 2024, 15: 1339731. doi: 10.3389/fendo.2024.1339731

[18] Zhou TF , Mao JS , Zhu P , et al. Association between the systemic immuno-inflammation index and hearing loss: result from NHANES 2009-2018[J]. Front Neurol, 2024, 15: 1369492. doi: 10.3389/fneur.2024.1369492

[19] He L , Xie H , Du YJ , et al. The relationship between C-reactive protein to lymphocyte ratio and the prevalence of myocardial infarction in US adults: a cross-sectional study[J]. Heliyon, 2023, 9(7): e17776. doi: 10.1016/j.heliyon.2023.e17776

[20] Jiang JJ , Tan HY , Xia ZF , et al. Serum vitamin D concentrations and sleep disorders: insights from NHANES 2011-2016 and Mendelian Randomization analysis[J]. Sleep Breath, 2024, 28(4): 1679-1690. doi: 10.1007/s11325-024-03031-2

[21] Golub JS , Brickman AM , Ciarleglio AJ , et al. Association of subclinical hearing loss with cognitive performance[J]. JAMA Otolaryngol Head Neck Surg, 2020, 146(1): 57-67. doi: 10.1001/jamaoto.2019.3375

[22] Reisinger L , Schmidt F , Benz K , et al. Ageing as risk factor for tinnitus and its complex interplay with hearing loss-evidence from online and NHANES data[J]. BMC Med, 2023, 21(1): 283. doi: 10.1186/s12916-023-02998-1

[23] 郭晓娟, 田国祥, 潘振宇, 等 . NHANES项目介绍及数据提取流程[J]. 中国循证心血管医学杂志, 2019, 11(6): 654-657. doi: 10.3969/j.issn.1674-4055.2019.06.03

[24] GUO Xiaojuan , TIAN Guoxiang , PAN Zhenyu , et al. NHANES project introduction And Data extraction process[J]. Chinese Journal of Evidence-Based Cardiovascular Medicine, 2019, 11(6): 654-657. doi: 10.3969/j.issn.1674-4055.2019.06.03

[25] 贾淳钰, 王淦淦, 王佳慧, 等 . 中性粒细胞/淋巴细胞比值与糖尿病患者eGFR的相关性: 基于NHANES数据库的横断面分析[J]. 协和医学杂志, 2025, 16(2): 379-385. doi: 10.12290/xhyxzz.2024-0908

[26] JIA Chunyu , WANG Ganggan , WANG Jiahui , et al. Correlation between neutrophil to lymphocyte ratio and eGFR in diabetic patients: a cross-sectional analysis based on NHANES data[J]. Medical Journal of Peking Union Medical College Hospital, 2025, 16(2): 379-385. doi: 10.12290/xhyxzz.2024-0908

[27] 林林, 陈常中, 余晓丹 . 应用Empower Stats软件分析阈值效应[J]. 中华流行病学杂志, 2013, 34(11): 1139-1141. doi: 10.3760/cma.j.issn.0254-6450.2013.011.021

[28] LIN Lin , CHEN Changzhong , YU Xiaodan . The analysis of threshold effect using Empower Stats software[J]. Chinese Journal of Epidemiology, 2013, 34(11): 1139-1141. doi: 10.3760/cma.j.issn.0254-6450.2013.011.021

[29] Gao XY , Qi JC , Du B , et al. Combined influence of nutritional and inflammatory status and breast cancer: findings from the NHANES[J]. BMC Public Health, 2024, 24(1): 2245. doi: 10.1186/s12889-024-19727-9

[30] Xu JP , Zeng RX , Zhang YZ , et al. Systemic inflammation markers and the prevalence of hypertension: a NHANES cross-sectional study[J]. Hypertens Res, 2023, 46(4): 1009-1019. doi: 10.1038/s41440-023-01195-0

[31] Hu BH , Zhang CL , Frye MD . Immune cells and non-immune cells with immune function in mammalian cochleae[J]. Hear Res, 2018, 362: 14-24. doi: 10.1016/j.heares.2017.12.009

[32] 刘宇超, 尹时华 . 炎症因子及其相关信号通路在内耳疾病中的研究进展[J]. 中华耳科学杂志, 2021, 19(3): 506-510. doi: 10.3969/j.issn.1672-2922.2021.03.020

[33] LIU Yuchao , YIN Shihua . Research progress regarding inflammatory factors and their signaling pathways in inner ear diseases[J]. Chinese Journal of Otology, 2021, 19(3): 506-510. doi: 10.3969/j.issn.1672-2922.2021.03.020

[34] Nash SD , Cruickshanks KJ , Zhan WH , et al. Long-term assessment of systemic inflammation and the cumulative incidence of age-related hearing impairment in the epidemiology of hearing loss study[J]. J Gerontol A Biol Sci Med Sci, 2014, 69(2): 207-214. doi: 10.1093/gerona/glt075

[35] Kang JW , Kim MG , Kim SS , et al. Neutrophil-lymphocyte ratio as a valuable prognostic marker in idiopathic sudden sensorineural hearing loss[J]. Acta Otolaryngol, 2020, 140(4): 307-313. doi: 10.1080/00016489.2019.1705998

[36] 刘达, 塞娜, 秦含黛, 等 . 噪声损伤引起小鼠耳蜗炎症复合体NLRP3激活及氢气的抑制作用[J]. 中华耳科学杂志, 2022, 20(1): 116-120. doi: 10.3969/j.issn.1672-2922.2022.01.023

[37] LIU Da , SAI Na , QIN Handai , et al. Noise-induced NLRP3 activation and inhibiting by hydrogen in mice cochlei[J]. Chinese Journal of Otology, 2022, 20(1): 116-120. doi: 10.3969/j.issn.1672-2922.2022.01.023

[38] Arpornchayanon W , Canis M , Ihler F , et al. TNF-α inhibition using etanercept prevents noise-induced hearing loss by improvement of cochlear blood flow in vivo[J]. Int J Audiol, 2013, 52(8): 545-552. doi: 10.3109/14992027.2013.790564

[39] Zahorec R . Neutrophil-to-lymphocyte ratio, past, present and future perspectives[J]. Bratisl Lek Listy, 2021, 122(7): 474-488. doi: 10.4149/BLL_2021_078

[40] 庞振文, 黄愉峰, 杨爱芳, 等 . 喉癌患者术前中性粒细胞/淋巴细胞比值与淋巴结转移的相关性研究[J]. 山东大学耳鼻喉眼学报, 2020, 34(6): 58-62. doi: 10.6040/j.issn.1673-3770.0.2019.546

[41] PANG Zhenwen , HUANG Yufeng , YANG Aifang , et al. Correlation between Preoperative neutrophil/lymphocyte ratio and lymph node metastasis in patients with laryngeal cancer[J]. Journal of Otolaryngology and Ophthalmology of Shandong University, 2020, 34(6): 58-62. doi: 10.6040/j.issn.1673-3770.0.2019.546

[42] 马静远, 武天义, 孙占伟, 等 . 鼻腔鼻窦内翻性乳头状瘤与外周血炎症标志物的相关性研究[J]. 山东大学耳鼻喉眼学报, 2022, 36(4): 35-39. doi: 10.6040/j.issn.1673-3770.0.2021.264

[43] MA Jingyuan , WU Tianyi , SUN Zhanwei , et al. Correlation between sinonasal inverted Papilloma and peripheral inflammatory blood markers[J]. Journal of Otolaryngology and Ophthalmology of Shandong University, 2022, 36(4): 35-39. doi: 10.6040/j.issn.1673-3770.0.2021.264

[44] 袁钰淇, 曹子讷, 牛晓欣, 等 . 外周血炎症指标在阻塞性睡眠呼吸暂停低通气综合征伴高血压中的临床意义[J]. 山东大学耳鼻喉眼学报, 2023, 37(6): 85-92. doi: 10.6040/j.issn.1673-3770.0.2023.174

[45] YUAN Yuqi , CAO Zine , NIU Xiaoxin , et al. Clinical significance of peripheral blood inflammatory markers in obstructive sleep apnea hypopnea syndrome with hypertension[J]. Journal of Otolaryngology and Ophthalmology of Shandong University, 2023, 37(6): 85-92. doi: 10.6040/j.issn.1673-3770.0.2023.174

[46] Doo JG , Kim D , Kim Y , et al. Biomarkers suggesting favorable prognostic outcomes in sudden sensorineural hearing loss[J]. Int J Mol Sci, 2020, 21(19): 7248. doi: 10.3390/ijms21197248

[47] 朱红美, 黄永久, 储九圣, 等 . 中性粒细胞/淋巴细胞比率和单核/高密度脂蛋白胆固醇比率在突发性耳聋患者中的表达水平及与预后的相关性[J]. 实用医学杂志, 2024, 40(24): 3503-3508. doi: 10.3969/j.issn.1006-5725.2024.24.011

[48] ZHU Hongmei , HUANG Yongjiu , CHU Jiusheng , et al. Expression level of neutrophil/lymphocyte ratio and monocyte/high density lipoprotein cholesterol ratio in patients with sudden deafness and their correlation with prognosis[J]. The Journal of Practical Medicine, 2024, 40(24): 3503-3508. doi: 10.3969/j.issn.1006-5725.2024.24.011

[49] Tan WJT , Song L . Role of mitochondrial dysfunction and oxidative stress in sensorineural hearing loss[J]. Hear Res, 2023, 434: 108783. doi: 10.1016/j.heares.2023.108783

[50] 黄巧, 任毅, 侯涛, 等 . 系统免疫炎症指数对突发性聋患者预后的影响[J]. 听力学及言语疾病杂志, 2022, 30(6): 613-616. doi: 10.3969/j.issn.1006-7299.2022.06.010

[51] HUANG Qiao , REN Yi , HOU Tao , et al. Effect of systemic immune-inflammatory index and the prognosis of patients with sudden deafness[J]. Journal of Audiology and Speech Pathology, 2022, 30(6): 613-616. doi: 10.3969/j.issn.1006-7299.2022.06.010

[52] Drăgoescu AN , Pădureanu V , Stănculescu AD , et al. Neutrophil to lymphocyte ratio (NLR)-a useful tool for the prognosis of sepsis in the ICU[J]. Biomedicines, 2021, 10(1): 75. doi: 10.3390/biomedicines10010075

[53] Shah N , Parikh V , Patel N , et al. Neutrophil lymphocyte ratio significantly improves the Framingham risk score in prediction of coronary heart disease mortality: insights from the National Health and Nutrition Examination Survey-III[J]. Int J Cardiol, 2014, 171(3): 390-397. doi: 10.1016/j.ijcard.2013.12.019

[54] Islam MM , Satici MO , Eroglu SE . Unraveling the clinical significance and prognostic value of the neutrophil-to-lymphocyte ratio, platelet-to-lymphocyte ratio, systemic immune-inflammation index, systemic inflammation response index, and delta neutrophil index: an extensive literature review[J]. Turk J Emerg Med, 2024, 24(1): 8-19. doi: 10.4103/tjem.tjem_198_23

基金资助

南通市卫健委科研课题青年指令性项目(QN2023062)