Study Of The Correlation Of Systemic Inflammatory Response Index And Atherogenic Index Of Plasma With Coronary Artery Disease And Severity Of Coronary Lesions

Objective:Based on the theory that immune inflammatory response and lipid metabolism disorders are associated with the occurrence and development of atherosclerosis(AS),we studied the changes in the levels of systemic inflammatory response index(SIRI)and atherogenic index of plasma(AIP)in patients with coronary artery disease(CAD)and their correlation with the severity of coronary artery lesions,and evaluated the value of SIRI,AIP and SIRI combined with AIP for the diagnosis of CAD.Methods:Case data were retrospectively collected from 311 patients who were admitted to the Department of Cardiovascular Medicine of Taiyuan Central Hospital,Shanxi Medical University with symptoms of chest suffocation and chest pain between January 1,2021 and December 31,2021 and had their first coronary angiography(CAG)completed.The general baseline data,laboratory indicators and CAG findings of all patients were collected by checking the electronic medical records,and the patients were included in the CAD group(n=183)and the non-CAD control group(n=128)according to the CAG findings.The general baseline data,laboratory indicators and changes in SIRI and AIP levels of the two groups were compared,and univariate and multifactorial Logistic regression models were established to screen independent risk factors for the occurrence of CAD.Based on the coronary artery Gensini(GS)score of patients in the CAD group,the CAD group was further classified as three subgroups of mild lesions(GS≤16 points,n=63),moderate lesions(16 points<GS≤29 points,n=60)and severe lesions(GS>29 points,n=60)using the three-point method.We compared the differences of SIRI and AIP levels between the non-CAD and CAD subgroups and their correlation with the severity of coronary lesions,and plotted receiver operating characteristic(ROC)curves to assess the diagnostic value of SIRI,AIP and SIRI combined with AIP for CAD.Results:(1)Comparison of general baseline and clinical data between the two groups:There were statistically significant differences between the CAD and non-CAD groups in terms of age,precentage of male,history of hypertension,diabetes mellitus and smoking,and peripheral blood white blood cell count,neutrophil count,lymphocyte count,monocyte count,platelet count,platelet distribution width,albumin,creatinine,uric acid,homocysteine,triglycerides and high-density lipoprotein(P<0.05).Compared to the non-CAD group,patients in the CAD group had significantly higher laboratory results except for lower levels of lymphocyte count,albumin and high-density lipoprotein.The visible differences in body mass index,mean platelet volume,red blood cell distribution width,alanine aminotransferase,aspartate aminotransferase,blood urea nitrogen,total cholesterol and low-density lipoprotein between the two groups were not observed(P>0.05).(2)Comparison of SIRI and AIP levels between the two groups:Compared with non-CAD group,SIRI and AIP levels in CAD group were significantly increased(P<0.05).(3)Univariate logisitic regression analysis:male,older age,previous hypertension,diabetes mellitus,smoking and elevated levels of white blood cell count,neutrophil count,monocyte count,creatinine,uric acid,homocysteine,SIRI,AIP and reduced lymphocyte count were associated with the occurrence of CAD(p<0.05).(4)Multifactorial logistic regression analysis:high levels of SIRI(OR:3.712,95%CI:1.682-8.146),AIP(OR:29.274,95%CI:6.843-125.238)and older age,previous diabetes mellitus,and elevated peripheral blood platelet count were considered independent hazard factors for the development of CAD(p<0.05).(5)Comparison of SIRI and AIP levels between the non-CAD group and different subgroups of CAD:the SIRI and AIP levels of patients in the four groups were significantly different at multiple comparisons between groups(P<0.05).Compared with the patients in non-CAD group,the levels of SIRI and AIP in all three subgroups of CAD were significantly higher(P<0.05).The levels of SIRI and AIP increased with the severity of lesions,however,this change in SIRI levels was more significant between the mild and severe lesion groups and between the moderate and severe lesion groups(P<0.05),but not between the mild and moderate lesion groups(P>0.05);this change in AIP levels was more significant between the mild and moderate lesion groups and between the mild and severe lesion groups(P<0.05),while the difference was not found to be a statistical significance between the moderate and severe lesion groups(P>0.05).(6)Correlation analysis between SIRI and AIP levels and GS score in CAD group:SIRI(r=0.414,P<0.001)and AIP(r=0.357,P<0.001)levels of patients in the CAD group showed a clear positive correlation with GS score.(7)ROC curves were plotted to evaluate the diagnostic value of SIRI,AIP and SIRI combined with AIP for CAD:The ROC curve showed that SIRI has the highest diagnostic value for CAD when the SIRI value was 0.96×10~9/L,and its area under the curve(AUC)for CAD diagnosis was 0.780(95%CI:0.729-0.832,P<0.05),sensitivity was 67.80%and specificity was 74.20%;the best cut-off value of AIP for dignosing CAD was 0.20,with an AUC of 0.748(95%CI:0.693-0.802,P<0.05),sensitivity of 65.00%and specificity of72.7%;the best cut-off value of SIRI combined with AIP dignosing CAD was 0.51,with an AUC of 0.832(95%CI:0.787-0.877,P<0.05),with a sensitivity of 80.30%and a specificity of 71.10%.Compared with SIRI or AIP,the AUC of SIRI combined with AIP was the largest for the diagnosis of CAD,and the AUC difference was statistically significant for comparison(P<0.05).Therefore,SIRI combined with AIP can improve the diagnostic value for CAD significantly.Conclusion:1.The levels of SIRI and AIP in CAD patients are significantly higher than those in non-CAD patients with normal coronary angiography(CAG)results,and are independent risk factors for CAD;2.There is a clear positive correlation between the levels of SIRI and AIP and the severity of coronary lesions in CAD patients,which has implications for guiding clinicians to assess the severity of coronary lesions in CAD patients early;3.Both SIRI and AIP levels have certain diagnostic value for patients with CAD,and the combination of the two makes more sense.In primary hospitals with relatively limited medical conditions,medical parctitioners can refer to the changes in the levels of SIRI and AIP to identify CAD early and guide patients to take preventive measures as soon as possible to avoid the occurrence of adverse cardiovascular events.