血清C反应蛋白和清蛋白比值与急性脑梗死患者颈动脉狭窄的关系研究

Correlation between the ratio of serum C-reactive protein and albumin and carotid artery stenosis in patients with acute cerebral infarction

目的探讨血清C反应蛋白和清蛋白比值(CAR)与急性脑梗死(ACI)患者颈动脉狭窄(CAS)程度之间的关系。方法收集2021年1月至2021年12月青海省人民医院首次发生ACI并经全脑数字减影血管造影术(DSA)检查的中老年住院患者285例,根据DSA检查后有无CAS分为对照组(74例)及狭窄组(211例),并根据狭窄程度将狭窄组分为3个亚组:轻度狭窄组(狭窄率<50%,79例)、中度狭窄组(50%≤狭窄率<70%,65例)、重度狭窄及闭塞组(狭窄率≥70%,67例);对比分析对照组与狭窄组、以及与狭窄组中各亚组的基线资料及实验室检查指标的差异,采用二元有序Logistic回归分析影响ACI患者CAS严重程度的危险因素。采用受试者工作特征(ROC)曲线评估CAR对ACI患者发生CAS的诊断价值。结果狭窄组CAR高于对照组(P<0.05);重度狭窄及闭塞组CAR明显高于对照组、轻度度狭窄组及中度狭窄组,中度狭窄组CAR明显高于对照组及轻度狭窄组,轻度狭窄组CAR明显高于对照组(均P<0.05)。采用二元有序Logistic回归分析发现CAR为ACI患者CAS的危险因素(P<0.05)。ROC曲线显示,CAR诊断ACI患者发生CAS的最佳截断值为0.331,曲线下面积(AUC)为0.703(95%CI:0.639~0.768,P<0.05),其诊断ACI患者发生CAS的灵敏度为68.2%,特异度为64.9%。结论CAR与ACI患者发生CAS存在一定联系,CAR可作为诊断ACI患者发生CAS的可靠指标。

Objective To investigate the correlation between serum C-reactive protein/albumin ratio(CAR)and carotid artery stenosis(CAS)in patients with acute cerebral infarction(ACI).Methods A total of 285 middle-aged and elderly inpatients who had ACI for the first time and underwent whole brain digital subtraction angiography(DSA)examination in Qinghai Provincial People's Hospital from January 2021 to December 2021 were collected.They were divided into the control group(74 cases)and the stenosis group(211 cases)according to whether there was carotid stenosis after DSA,and the stenosis group was divided into three subgroups according to the degree of stenosis:mild stenosis group(stenosis rate<50%,79 cases),moderate stenosis group(50%≤stenosis rate<70%,65 cases),and severe stenosis and occlusion group(stenosis rate≥70%,67 cases).The differences of baseline data and laboratory tests indexes between the control group and the stenosis group as well as between each subgroup in the stenosis group were comparatively analyzed,and the risk factors influencing the severity of CAS in patients with ACI were analyzed by using binary ordered Logistic regression.Receiver operating characteristic(ROC)curve was used to assess the predictive value of CAR for the development of CAS in patients with ACI.Results The CAR in the stenosis group was higher than that in the control group(P<0.05).As for the comparison of CAR between the control group and the three subgroups,CAR in the severe stenosis and occlusion group were significantly higher than those in the control group,the mild stenosis group,and the moderate stenosis group(P<0.05).CAR in the moderate stenosis group were significantly higher than those in the control group and the mild stenosis group(P<0.05).CAR in the mild stenosis group were significantly higher than those in the control group(P<0.05).Binary ordered Logistic regression analysis results showed that CAR was a risk factor for CAS in patients with ACI(P<0.05).According to ROC curve,the optimal cut-off value of CAR for predicting CAS in patients with ACI was 0.331,the area under the curve(AUC)was 0.703(95%CI:0.639-0.768,P<0.05).The sensitivity and specificity of CAR for diagnosing CAS in patients with ACI were 68.2%and 64.9%,respectively.Conclusion There is certain relationship between CAR and the occurrence of CAS in ACI patients,and CAR could serve as a reliable indicator for diagnosing CAS in ACI patients.