Correlation Between Serum High-Sensitivity C-Reactive Protein/Albumin Ratio And White Matter Hypertensity Of Presumed Vascular Origin

Background White Matter Hypertensity of presumed vascular origin（WMH）refer in particular to vasogenic white matter lesions,excluding those caused by neuroimmunity,infection,metabolism or poisoning,etc.It is one of the main types of cerebral small vessel diseases（CSVD）.Various mechanisms,including inflammation,endothelial failure,and blood-brain barrier dysfunction,have been proposed to explain the pathogenesis of WMH.C-reactive protein（CRP）is a sensitive but non-specific indicator of inflammatory factors involve that participates in local or systemic inflammatory response.High sensitivity C-response protein（hs-CRP）is more sensitive than CRP,nd can detect low levels of CRP concentration.Serum albumin（ALB）can reflect the nutritional status and liver function of the body,and can be used to judge the severity of the disease.In recent years,hs-CRP/ALB ratio（CAR）has been widely used in the research of inflammatory response-related diseases as a newer inflammatory index.Some studies have found that the level of CAR is closely related to the prognosis of cerebral infarction and acute coronary syndrome.However,the relationship between the level of CAR and WMH is still inconclusive.Whether CAR,as an inflammatory indicator,participates in the pathogenesis of WMH and whether it is related to the development of WMH is worth further study.Objective To investigate the correlation between serum hs-CRP/ALB（CAR）and WMH and its relationship with the degree of WMH,in order to provide some guiding value for the early prediction and prevention of WMH.Method From February 2020 to February 2021,A total of 119 patients with WMH from the neurology depatment of Chaohu Hospital Of Anhui Medical University were enrolled.At the same time,30 people without white matter lesions from outpatient or physical examination center were selected as control group.Collect subjects general clinical data（age,gender,history of disease history of smoking and drinking）,head MRI examination and laboratory indexes（total cholesterol,homocysteine,D-dimer,hs-CRP,propagated）,and the h S-CRP/ALB（CAR）ratio was calculated.The Fazekas scale was used to score the paraventricular and deep white matter lesions of patients with brain MRI,and the patients with WMH were divided into mild group（WMH 1level）49 cases,moderate group（WMH 2level）38 cases,and severe group（WMH 3level）32 cases.The statistical difference between CAR level and research objects among groups was analyzed.The above data were analyzed by SPSS20.0 software,and P<0.05 indicated statistically significant differences.Results（1）There were no significant differences in gender,diabetes history,smoking history,drinking history and total cholesterol between WMH group（119 cases）and control group（30 cases）（P>0.05）.Compared with the control group,patients in WMH group were older,had a higher proportion of hypertension and previous stroke,and the levels of HCY,HS-CRP and CAR were higher than those in the control group,while the serum ALB level was lower than that in the control group,the differences were statistically significant（P<0.05）.（2）With or without WMH as the dependent variable and risk factors as the inde pendent variable,logistic regression analysis showed that Age[OR=1.083,95%CI（1.014-1.156）],hypertension[OR=5.049,95%CI（1.032-24.711）],CAR[OR=1.504,95%CI（1.050-2.153）] were independent risk factors for WMH.ALB[OR=0.773,95%CI（0.612-0.975）] was a protective factor for WMH lesions（P<0.05）.（3）Age,hypertension,past stroke history,HCY,hs-CRP,ALB and CAR were correlated with the severity of WMH（P<0.05）.（4）The ordered logistic regression analysis based on the severity of WMH showed that age[OR=1.182,95%CI（1.103-1.266）],hypertension[OR=3.629,95%CI（1.519-8.662）] and CAR[OR=1.467,95%CI（1.255-1.714）] were independent risk factors for the increase of WMH severity.（5）Spearman correlation analysis showed that the severity of WMH was positively correlated with hs-CRP and CAR.WMH severity was negatively correlated with ALB,with statistical significance（P<0.05）.Among them,the correlation coefficient between CAR and WMH was the highest（r=0.574）.（6）The reliability of hs-CRP,ALB and CAR on WMH lesions was analyzed by receiver operating characteristic（ROC）curve.The area under the ROC curve for CAR to predict the reliability of WMH lesions was 0.791（95% confidence interval 0.718-0.864;P<0.001）,hs-CRP and ALB were 0.786 and 0.335 respectively.The area under the curve of CAR was the largest.Combined with ROC curve coordinates,the Yuden index of CAR was calculated.When the optimal cut-off value was 1.90,the sensitivity and specificity were 0.766 and 0.714.These results suggest that CAR has a high predictive value for WMH occurrence.Conclusions Hs-CRP,ALB and CAR were associated with WMH.In WMH patients,hs-CRP and CAR were positively correlated with the severity of WMH,while ALB was negatively correlated with the severity of WMH.CAR could be used to predict the occurrence of WMH,and its predictive value was better than hs-CRP or ALB alone.