| Part I The Study on the Relationship between C-reactive protein to albumin ratio and Coronary Heart DiseaseObjective: The role of inflammation in Coronary heart disease(CHD)has been paid more attention,and the C-reactive protein to albumin ratio(CAR)is considered to be a better predictor of inflammation than CRP and albumin.The purpose of this study was to investigate the correlation between CAR ratio and CHD and its predictive value in the early diagnosis of CHD.Methods: A total of 257 CHD patients and 81 control patients(negative coronary angiography)admitted to Hainan People’s Hospital from March 2019 to August 2020 were included in this study.The CHD group was further divided into two subgroups: stable angina pectoris subgroup(SA group,89cases)and acute coronary syndrome subgroup(ACS group,168 cases).Routine laboratory test data(blood routine,blood biochemistry,blood lipid profile,glucose metabolism index,liver and kidney function,etc.)were obtained at admission and the CAR were calculated to analyze the correlation between CAR ratio and coronary heart disease(CHD),stable angina pectoris(SA)and acute coronary syndrome(ACS).ROC curve was used to analyze the diagnostic value of CAR ratio in CHD,SA and ACS.Results:1.CAR,CRP and NLR in the CHD group were higher than those in the control group,the differences were statistically significant(P<0.001),and albumin was lower than that in the control group,the differences were statistically significant(P<0.05);2.In different types of coronary heart disease groups,CAR,CRP and NLR gradually increased with the progression of CHD,presenting as the acute coronary syndrome>the stable angina pectoris group>the control group,there were statistically significant differences in CAR,CRP and NLR values between the control group,SA group and ACS group after pairs comparison(P<0.001);Albumin in ACS group was significantly lower than that in SA group and control group,and the difference was statistically significant(P<0.05);3.Multiple logistic regression analysis showed that CAR,CRP and NLR were still independent risk factors for CHD and ACS when other related risk factors were fixed,but there was no significant correlation between CAR,CRP,NLR and SA;Albumin had no statistical significance with CHD,SA and ACS;4.ROC curve analysis showed that the AUC of CAR value in diagnosis of CHD was 0.711(95%CI:0.648-0.774,P<0.001),and that of ACS was0.764(95%CI: 0.712-0.815,P<0.001),both larger than the line area of CRP,NLR and CK-MB,but smaller than that of TNT;The optimal cut-off point for CAR diagnosis of CHD was 8.209,with a sensitivity of 59.1% and a specificity of 76.6%,The optimal cut-off point for CAR diagnosis of ACS was10.147,with a sensitivity of 62.5% and a specificity of 78.4%;CAR,CRP,NLR,CK-MB and TNT had no significant diagnostic value for SA(AUC<0.5);Albumin had no statistical significance in the diagnosis of CHD and SA(P>0.05),but had certain predictive value in the diagnosis of ACS subgroup.Conclusion:1.The CAR in CHD patients was significantly higher than that in the control group,and increased gradually with the progression of CHD,which was an independent risk factor for CHD and ACS;2.The CAR has a certain predictive value in the early diagnosis of CHD,especially ACS,and is better than CRP,albumin,NLR,CK-MB;3.CRP and NLR are significantly correlated with coronary heart disease and ACS,and are independent risk factors for coronary heart disease and ACS,and have certain diagnostic value for coronary heart disease,especially ACS;4.There is a certain correlation between albumin and CHD and ACS,but it is not an independent influencing factor of CHD and ACS,and it has no statistical value for the diagnosis of CHD,but it has certain diagnostic value for the subgroup of ACS;5.CAR,CRP,NLR and albumin had no statistical correlation with SA,and there was no significant statistical significance for the early diagnosis of SA.Part II Correlation between CAR and the severity of coronary artery diseaseObjective: By studying the correlation between C-reactive protein to albumin ratio(CAR)and the number of coronary artery lesions and Gensini score to explore the correlation between CAR and the severity of coronary artery lesions,so as to explore the application value of CAR ratio in the severity of coronary artery disease.Methods: A total of 338 patients were enrolled and divided into CHD group(257 cases)and control group(81 cases)according to coronary angiography results.According to the number of coronary vessel lesions,the CHD group was further divided into single-vessel lesion group(96 cases),double-vessel lesion group(78 cases)and multi-vessel lesion group(81 cases).At the same time,the CHD group was further divided into mild stenosis group (144 cases),moderate stenosis group(61 cases)and severe stenosis group(52 cases)according to Gensini score.The blood routine,blood biochemical,lipid profile,liver and kidney function,glucose metabolism and other indexes of the participants were measured respectively,and the CAR was calculated.The correlation between the CAR ratio and the number of coronary artery lesions and Gensini score was analyzed and compared,so as to evaluate the correlation between CAR and the severity of coronary artery lesions.Results:1.CAR ratio increased gradually with the increase of coronary lesion counts,presenting as multivessel lesions group>double branch lesions>single lesion group > control group,by pairs comparing,the CAR ratio between a single lesion group(P<0.01),the double branch lesion group(P<0.001),multivessel disease lesion(P<0.001)and the control group,the single lesion group and the multivessel lesions group,the double branch lesions group and multivessel disease group(P<0.001),in the comparison of the difference were significant statistical significance;2.CAR increased with the increase of narrowed coronary artery lesions increased gradually,as coronary severe stenosis group>coronary moderate stenosis group > coronary mild stenosis > control group,after Pairwise comparison,CAR in the group of mild stenosis(P<0.01),moderate stenosis(P<0.001),severe stenosis group(P<0.001)compared with control group,mild stenosis group compared with the moderate stenosis group(P<0.001),and mild stenosis group compared with severe stenosis group(P<0.001),the differences are statistically significant meaning;3.Spearman correlation analysis shows,in the study on the number of coronary artery lesions,CAR and CRP were positively correlated with the number of coronary artery lesions(P<0.001),while albumin was negatively correlated with the number of coronary artery lesions(P < 0.001).The correlation coefficients of CAR were all higher than that of CRP and albumin(rS=0.375 VS rS=0.248 VS rS=0.200),while NLR was not statistically correlated with the number of coronary artery lesions(P>0.05).In the Gensini score,CAR(P<0.001),CRP(P<0.001),NLR(P<0.01)were positively correlated with Gensini score,and the correlation coefficient of CAR was also better than that of CRP and NLR(r S =0.407 VS r S =0.382 VS r S =0.187),while albumin had no statistical correlation with Gensini score(P>0.05).Conclusion:1.The CAR gradually increased with the increase of the number of coronary vessel lesions and the degree of coronary artery stenosis,and there was a significant correlation with the number of multi-vessel coronary artery lesions and the Gensini score in the middle and high group,showing a significant positive correlation,which has a certain evaluation value for the severity of coronary artery lesions in patients with coronary heart disease2.CAR is better than alone CRP,albumin and NLR in evaluating the severity of coronary artery disease. |
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