The Clinical Value Of Atherogenic Index Of Plasma In Evaluating Arteriosclerosis In Patients With Primary Nephrotic Syndrome

Objective:To explore the relationship between the Atherogenic index of plasma(AIP)in patients with primary nephrotic syndrome(PNS),and assess the severity of the predictive value for atherosclerosis;evaluate whether AIP is more reliable than traditional blood lipid indexes in evaluating atherosclerosis in patients with PNS.Methods:Retrospectively analysis of the data of 110 patients with primary nephrotic syndrome in the department of renal medicine(from January 1,2019 to February 28,2021).All objects met the inclusion criteria.Baseline data of patients were collect including general projects(gender,age,height,weight,etc.),and laboratory results were collect as follow:Triglyceride(TG),high-density lipoprotein(HDL),low density lipoprotein(LDL),white blood cell(WBC),total cholesterol(TC),lymphocyte(LYM),neutrophile granulocyte(NEUT),red blood cell(RBC),Hemoglobin(Hb),platelet(PLT),uric acid(UA),albumin(ALB),blood creatinine(Cr),blood calcium(Ca),phosphorus(P),iron(Fe).Imaging examination(chest CT,cervical vascular ultrasonic,etc.),and symptom onset time and the length of hospitalization,and other indicators.In order to avoid negative values of AIP and ensure the normal distribution of data,we use adjusted AIP:AIP multiply by 100 and then take its logarithmic value during analysis:adjusted AIP(aAIP)=log[(TG/HDL-C)×100].The aAIP was calculated and all patients were divided into atherosclerosis group(IMT≥1.0mm)and non-atherosclerosis group(IMT<1.0mm)based on carotid vascular ultrasound.Differences in various indicator between the two groups were compared.Risk factors for atherosclerosis were detected by logistic regression.Spearman correlation was used to evaluate the correlation between AIP and other indicators.The ROC curve was used to determine the best cut-off value for AIP、Apo(E)and Apo(a)diagnosis of atherosclerosis,and discusse the potential significance of the threshold Apo(E)and Apo(a)combined AIP in atherosclerosis diagnosis.p<0.05 there were significant differences.Results:1.The results showed that the age of the atherosclerosis group was higher compared with non-atherosclerosis group(P<0.001).2.In terms of laboratory indicators,the expression of D-dimer,urea nitrogen,complement C4,triglyceride,free cholesterol,apolipoprotein E,apolipoprotein a in atherosclerosis group were obviously increased,while the glomerular filtration rate and phosphorus was decreased in atherosclerosis group compared with non-atherosclerosis group(P<0.05).3.Multivariate Logistic regression analysis found that AIP was an important independent risk factor for PNS patient with atherosclerosis.4.ROC analysis shows that the optimal threshold value for AIP to predict atherosclerosis in PNS patients was 2.435,the sensitivity and specificity were 62.5%and 71.8%,and the Area under the curve(AUC)was 0.646(95%CI:0.526-0.766,p=0.017,P<0.05).5.In addition,the sensitivity,specificity,and area under the curve were 68.8%、65.4%,and 0.691 when using AIP combined apo(a)to predict the atherosclerosis in PNS patients,and which were 68.8%、82.1%and 0.732 using AIP combined apo(E),respectively.Conclusions:1.AIP is an independent risk factor for PNS patients with atherosclerosis.2.The higher the AIP value,the larger amount of urinary protein and the lower levels of the protein albumin in serum.3.Compared with traditional lipids,AIP is of higher value in evaluating atherosclerosis in PNS patients,can be used as a biological indicator to evaluate the disease condition.Combined with APO(E)or APO(a)for diagnosis can credibly improve sensitivity and specificity,and provide an early detection method for evaluating the prognosis of patients and preventing cardiovascular events.