纤维蛋白原与白蛋白比值对颈动脉粥样硬化不稳定斑块的预测价值

Value of fibrinogen to albumin ratio in predicting unstable carotid atherosclerotic plaques

目的探讨纤维蛋白原与白蛋白比值(fibrinogen to albumin ratio,FAR)对颈动脉粥样硬化不稳定斑块的预测价值。方法在郑州大学第五附属医院2016年12月~2019年12月诊断颈动脉狭窄并行颈动脉内膜剥脱术患者共116例,根据术后斑块病理组织学检测结果,将患者分为稳定斑块组47例和不稳定斑块组69例。分析2组患者基线资料、FAR及其他检验结果的差异,采用多因素logistic回归分析筛选颈动脉粥样硬化不稳定斑块的影响因素,采用ROC曲线评价FAR对颈动脉粥样硬化不稳定斑块的预测价值。结果不稳定斑块组FAR、红细胞分布宽度、血尿酸水平明显高于稳定斑块组(P<0.05,P<0.01)。多因素logistic回归分析显示,FAR(OR=1.448,95%CI:1.216~1.723,P=0.000)、红细胞分布宽度(OR=1.642,95%CI:1.075~2.507,P=0.022)和血尿酸(OR=1.007,95%CI:1.001~1.012,P=0.031)是颈动脉粥样硬化不稳定斑块的独立危险因素。ROC曲线分析显示,FAR、红细胞分布宽度、血尿酸预测颈动脉粥样硬化不稳定斑块的曲线下面积分别为0.767(95%CI:0.672~0.862,P=0.000),0.709(95%CI:0.608~0.810,P=0.000),0.631(95%CI:0.526~0.736,P=0.017)。FAR的ROC曲线下面积虽高于红细胞分布宽度和血尿酸,但差异无统计学意义(P>0.05)。FAR最佳诊断临界值为0.09,敏感性为84.1%,特异性为66.0%。结论FAR对颈动脉粥样硬化患者不稳定斑块具有良好的预测价值。

Objective To study the value of fibrinogen to albumin ratio(FAR)in predicting unstable carotid atherosclerotic plaques.Methods One hundred and sixteen carotid stenosis patients who underwent carotid endarterectomy in our hospital from December 2016 to December 2019 were divided into stable plaque group(n=47)and unstable plaque group(n=69).The difference in baseline data,FAR and other laboratory testing parameters between the two groups was analyzed.The influencing factors of unstable carotid atherosclerotic plaques were screened by multivariate logistic regression analysis.The value of FAR in predicting unstable carotid atherosclerotic plaques was assessed by ROC curve analysis.Results The FAR and serum UA level were significantly higher and the distribution width of red blood cells was significantly wider in unstable plaque group than in stable plaque group(P<0.05,P<0.01).The FAR,distribution width of red blood cells and serum UA level were the independent risk factors for unstable carotid atherosclerotic plaques(OR=1.448,95%CI:1.216-1.723,P=0.000;OR=1.642,95%CI:1.075-2.507,P=0.022;OR=1.007,95%CI:1.001-1.012,P=0.031).ROC curve analysis displayed that the AUC for FAR,distribution width of red blood cells and serum UA level in predicting unstable carotid atherosclerotic plaques was 0.767(95%CI:0.672-0.862,P=0.000),0.709(95%CI:0.608-0.810,P=0.000)and 0.631(95%CI:0.526-0.736,P=0.017)respectively.No significant difference was detected in AUC for FAR,distribution width of red blood cells and serum UA level in predicting unstable carotid atherosclerotic plaques(P>0.05)although the AUC for FAR was higher than that for distribution width of red blood cells and serum UA level in predicting unstable carotid atherosclerotic plaques.The sensitivity of FAR was 84.1%and the specificity of FAR was 66.0%in predicting unstable carotid atherosclerotic plaques when the cut-off point value was 0.09.Conclusion FAR can effectively predict unstable carotid atherosclerotic plaques in carotid atherosclerosis patients.