Correlation Between High-sensitivity C-reactive Protein/Albumin Ratio And Intracranial Atherosclerotic Stenosis In Patients With Cerebral Infarction

Background Cerebral infarction（CI）,also known as ischemic stroke,is one of the common diseases in neurology,and it is also the first cause of death and severe disability in Chinese adults.In China and even in the world,intracranial atherosclerosis is considered to be one of the main causes of ischemic stroke.Hypersensitive C-reactive protein/albumin ratio（CAR）is a new inflammatory marker associated with atherosclerosis and easy to monitor.Some studies have found that CAR can be used as a reliable index to predict the degree of coronary artery stenosis in patients with acute myocardial infarction,and the pathogenesis of cerebrovascular disease is similar to cardiovascular disease,however,the relationship between CAR and the severity of intracranial atherosclerotic stenosis（ICAS）in patients with cerebral infarction is still inconclusive.Whether CAR,as an inflammatory index is related to the occurrence and progression of ICAS is worthy of further study.Objective To investigate the correlation between hypersensitive C-reactive protein/albumin ratio（CAR）and the degree of intracranial atherosclerotic stenosis（ICAS）in patients with cerebral infarction,in order to provide some guidance value for the early prediction,evaluation and prevention of cerebral infarction.Method From April 2021 to September 2022,166 patients with large artery atherosclerosis（LAA）cerebral infarction treated in Chaohu Hospital affiliated to Anhui Medical University were selected,including 133 patients with ICAS as the observation group.Selected 53 case of dizziness complicated with ICAS in our hospital were selected as the control group.The general data（age,sex,hypertension,diabetes,Previous stroke history,smoking history and drinking history）and laboratory indexes（fibrinogen,D-dimer,homocysteine,uric acid,total cholesterol,triglyceride,low density lipoprotein,high density lipoprotein,glycosylated hemoglobin,hs-CRP,ALB）of each group were collected,and the hs-CRP/ALB（CAR）ratio was calculated.And improve head MRI and head and neck digital subtraction angiography（DSA）examination.According to the results of DSA,they were divided into non-ICAS group33 cases,mild ICAS group 40 cases,moderate ICAS group 35 cases and severe ICAS group 58 cases according to Samuels grade.According to the number of intracranial artery stenosis,patients with cerebral infarction were divided into three groups:non-ICAS group 33 cases,single-vessel ICAS group 53 cases and multi-vessel ICAS group 80 cases.The statistical difference between CAR level and research objects among groups was analyzed.The above data were analyzed by SPSS25.0 software,and P<0.05 indicated statistically significant differences.Results（1）There were no significant differences in age,sex,diabetes history,stroke history,smoking history and drinking history between the observation group and the control group（all P>0.05）,however,there was significant difference in hypertension（Χ²=4.330,P=0.037）between the two groups（P<0.05）.The levels of hs-CRP and CAR in the observation group were higher than those in the control group,while the level of serum ALB was lower than that in the control group,the differences were statistically significant（P<0.05）.（2）Hypertension,FIB,hs-CRP,ALB and CAR were correlated to the severity of ICAS in patients with cerebral infarction after pairwise comparison according to Samuels grade.（all P<0.05）.（3）According to the number of stenosis branches of intracranial artery,there were significant differences in hypertension and FIB.Hs-CRP and CAR increased gradually with the increase of the number of stenosis branches of intracranial atherosclerosis,however,serum ALB decreased step by step,with statistical significance（all P<0.05）.（4）In the study of ICAS severity in patients with cerebral infarction,Spearman correlation analysis showed that hs-CRP and CAR were positively correlated with ICAS severity.Pearson correlation analysis showed that ALB was negatively correlated with ICAS severity,with statistical significance（all P<0.05）.Among them,the correlation coefficient between CAR and ICAS was the highest（r=0.721）.（5）In the study of different intracranial artery stenosis numbers in patients with cerebral infarction,Spearman correlation analysis showed that hs-CRP and CAR were positively correlated with the number of stenosis branches.Pearson correlation analysis showed that ALB was negatively correlated with the number of stenosis branches,with statistically significant（all P<0.05）.Among them,the correlation coefficient between CAR and stenosis branches was the highest（r=0.535）.（6）The ordered logistic regression analysis based on the severity of ICAS in patients with cerebral infarction showed that hypertension[OR=0.447,95%CI（0.220-0.906）],and CAR[OR=1.611,95%CI（1.408-1.843）]were independent risk factors for the increase of ICAS severity.ALB[OR=0.802,95%CI（0.708-0.908）]was protective factor for the increase of ICAS severity（all P<0.05）.（7）The reliability of hs-CRP,ALB and CAR in predicting the severity of ICAS was analyzed by receiver working（ROC）curve.The area under the ROC curve for CAR to predict the reliability of ICAS in patients with LAA cerebral infarction was 0.859（95%CI:0.797-0.920,P<0.001）,and the area under the curve of hs-CRP was 0.855（95%CI:0.793-0.981）.The area under the curve of ALB was 0.244（95%CI:0.171-0.318,P<0.001）.Among them,the area under the curve of CAR was the largest.Combined with the ROC curve coordinates,the Yuden index of CAR was calculated.When the best cut-off value is 7.35x10^-2,the sensitivity and specificity were 74.10%and 89.80%.It is suggested that CAR has a high predictive value for the occurrence of ICAS.Conclusions（1）hs-CRP,ALB and CAR were all significantly corrected with the occurrence and stenosis of ICAS in patients with cerebral infarction.（2）hs-CRP and CAR gradually increased with the increase of the degree of intracranial vascular stenosis and the number of intracranial vascular stenosis,showing a significant positive correlation,while the serum ALB decreased gradually with the increase of intracranial vascular stenosis and the number of intracranial vascular stenosis,showing a negative correlation.（3）CAR could be used to predict the occurrence of ICAS in patients with cerebral infarction,and the predictive value was better than hs-CRP or ALB alone.