Analysis Of The Predictive Value Of Fibrinogen To Albumin Ratio In Atherosclerotic Renal Artery Stenosis

BackgroundsRenal artery stenosis(RAS)is a kind of disease that causes lumen stenosis or occlusion of the main or branch of renal artery due to various reasons.There are many causes of RAS,including fibromuscular dysplasia(FMD),atherosclerosis and Takayasu arteritis(TA).In recent years,with the development of aging population in China,atherosclerotic renal artery stenosis(ARAS)has become the main cause of RAS.The early clinical manifestations of ARAS are often not specific,most of them are hypertension,which is mainly manifested in the hospital.Therefore,the discovery of RAS is often ignored,resulting in missed diagnosis and delayed treatment,which eventually leads to the continuous progress of the patient’s condition,ischemic nephropathy and refractory hypertension.At present,there are many clinical diagnostic methods for ARAS,including color doppler ultrasound(CDUS),magnetic resonance angiography(MRA)and computed tomography angiography(CTA)with high accuracy and clear display of renal artery they are widely used in clinical diagnosis because of its non-invasive and accuracy.However,the final diagnosis of RAS in clinic still depends on renal arteriography,which is the gold standard recommended by RAS guidelines at home and abroad.Renal arteriography has a good judgment on the degree of renal artery stenosis,blood perfusion,etc.,but it can not be used as a routine ARAS examination because of its invasive,expensive examination cost,hospitalization examination and the risk of complications.Fibrinogen is an acute phase reactive protein and pro-inflammatory marker.It can regulate the expression of pro-inflammatory cytokines,promote the activation and adhesion of macrophages,strengthen the vascular inflammatory response,change the permeability of vascular endothelium,accelerate the aggregation and oxidative modification of low density lipoprotein under vascular endothelium,lead to the proliferation and migration of vascular smooth muscle cells,and promote the proliferation of vascular smooth muscle cells The formation of atherosclerotic plaque.Albumin plays an important role in maintaining plasma colloidal osmotic pressure,transporting lipids and participating in inflammatory reaction in vivo.As a new inflammatory marker,fibrinogen to albumin ratio(FAR)is related to the severity and prognosis of coronary heart disease,the prognosis of tumor and the stability of carotid plaque.FAR is related to the occurrence and development of various vascular diseases.Therefore,we speculate whether far is related to the occurrence of ARAS.This study was to explore the correlation between far and the occurrence of ARAS.ObjectiveTo investigate the predictive value of fibrinogen to albumin ratio(FAR)in atherosclerotic renal artery stenosis(ARAS),and to analyze the risk factors of atherosclerotic renal artery stenosis,so as to provide reference value for clinical diagnosis of ARAS.MethodsRetrospective analysis of 161 hypertensive patients with suspected coronary artery disease who were hospitalized in the Department of Cardiovascular Medicine of the First Affiliated Hospital of Zhengzhou University from September 2014 to September 2019 for coronary angiography along with renal arteriography was divided into 2 groups according to the degree of stenosis revealed by renal arteriography:the ARAS group(n=49 cases)and the non-ARAS group(n=112 cases),and by The GENSINI score was used to score the coronary angiographic findings,and the severity of coronary artery disease was measured by the score results.The differences in clinical data,auxiliary examination results,FAR values,and GENSINI scores of patients between the 2 groups were compared.And single-factor logistic regression analysis was performed to screen out the risk factors of ARAS,and multi-factor logistic regression was performed to screen out the predictors of ARAS for the results obtained from single-factor analysis,and ROC curve analysis was applied to assess the predictive value of FAR on ARAS.Results1.Comparison of general information between ARAS and non-ARAS groups There were no statistical differences in gender,history of smoking,history of alcohol consumption,systolic blood pressure,diastolic blood pressure,history of diabetes mellitus and duration of hypertension between ARAS and non-ARAS groups(P>0.05),while age and peripheral vascular disease were significantly higher in the ARAS group than in the non-ARAS group,and the differences between the two groups were statistically significant(P<0.05).2.Comparison of laboratory test results and ancillary test results between ARAS and non-ARAS groups There were no statistically significant differences in NT-proBNP,blood potassium,fasting glucose,glycosylated hemoglobin,TC,TG,HDL,LDL,BUN,UA,neutrophil count,lymphocyte count,red blood cell distribution width,and LVEF between patients in the ARAS and non-ARAS groups(P>0.05);GENSINI score and FAR in the ASAR group were higher than those in the non-ASAR group,and the difference between the two groups was statistically significant(P<0.05);eGFR in the ASAR group was lower than that in the non-ARAS group,and the difference between the two groups was statistically significant(P<0.05).3.Single-factor logistic regression analysis showed that age,GENSINI score,peripheral vascular disease,eGFR,and FAR were risk factors for ARAS.Multi-factor logistic regression analysis,the results showed that FAR,peripheral vascular disease,and GENSINI score were independent risk factors for the development of ARAS.4.The results of subject operating characteristic curve(ROC)analysis showed that the area under the curve for FAR predicting ARAS formation was 0.764(95%CI:68.84%to 83.39%,P=0.000),with an optimal critical value of 72.17,sensitivity 0.735,and specificity 0.679.Conclusions1.FAR,GENSINI score and peripheral vascular disease are independent risk factors for the development of ARAS.2.FAR has a good predictive value for the formation of ARAS,and the higher the FAR of admitted patients,the higher the possibility of combined ARAS.