Yilmaz Halis, Turgul Cemre, Yilmaz Yucel, Kelesoglu Saban, Tuncay Aydin
Department of Cardiovascular Surgery, Erciyes University Faculty of Medicine, 38039 Kayseri, Türkiye.
Department of Cardiology, University of Health Sciences, Kayseri City Training and Research Hospital, 38080 Kayseri, Türkiye.
Medicina (Kaunas). 2025 Aug 21;61(8):1495. doi: 10.3390/medicina61081495.
: Carotid artery stenosis is an inflammatory vascular disease closely linked to atherosclerosis and associated with inflammatory biomarkers. The neutrophil/albumin ratio (NAR) is a novel promising biomarker in assessing cardiovascular disease severity. This study aimed to evaluate the relationship between NAR and lesion severity in patients with carotid artery stenosis. : This retrospective, single-center, comparative study included 625 asymptomatic patients who underwent digital subtraction angiography (DSA) for suspected high-grade carotid artery stenosis between 2012 and 2022. Patients were classified into two groups based on stenosis severity: critical carotid artery stenosis (≥70% stenosis) and non-critical carotid artery stenosis (<70%). Only asymptomatic patients were included; patients with symptoms were excluded. NAR was calculated preoperatively as neutrophil count divided by serum albumin. Additional inflammatory markers, such as neutrophil-lymphocyte ratio (NLR) and C-reactive protein (CRP) to albumin ratio (CAR), were also analyzed. : Severe carotid artery stenosis was detected in 191 of the patients who underwent DSA. Individuals in the critical carotid artery stenosis group were older and had a higher prevalence of diabetes mellitus and hypertension (51 (45-57) vs. 60 (54-68), < 0.001; 143 vs. 83, = 0.025; 193 vs. 104, respectively, = 0.021), as well as higher neutrophil counts (4.3 (3.2-6.2) vs. 8.1 (4.9-12.5), < 0.001), NLR (2.2 (1.4-3.2) vs. 4.2 (2.3-8.9), < 0.001), while CRP (3.8 (1.8-8) vs. 5.7 (3.6-7.6), = 0.005) and CAR (0.9 (0.5-1.9) vs. 1.6 (0.8-2.1), < 0.001) values were significantly higher. NAR was higher in patients of the critical carotid artery stenosis group than the non-critical (1.1 (0.8-1.6) vs. 2.1 (1.4-3.2), < 0.001). Multivariate analysis identified NAR as an independent predictor of carotid artery stenosis (Odds Ratio [OR]: 3.432; 95% Confidence Interval [CI]: 2.116-5.566; < 0.001). The best cut-off value of NAR for predicting critical carotid artery stenosis was 1.47, which provided 73.8% sensitivity and 70.5% specificity. : NAR, which can be easily measured through a simple blood test, demonstrated moderate sensitivity and specificity in predicting critical carotid artery stenosis, suggesting its potential role as a supportive marker in clinical risk assessment.
颈动脉狭窄是一种与动脉粥样硬化密切相关的炎症性血管疾病，并与炎症生物标志物有关。中性粒细胞/白蛋白比值（NAR）是评估心血管疾病严重程度的一种新的有前景的生物标志物。本研究旨在评估NAR与颈动脉狭窄患者病变严重程度之间的关系。
这项回顾性、单中心、对照研究纳入了625例在2012年至2022年间因疑似重度颈动脉狭窄而接受数字减影血管造影（DSA）的无症状患者。根据狭窄严重程度将患者分为两组：重度颈动脉狭窄（狭窄≥70%）和非重度颈动脉狭窄（狭窄<70%）。仅纳入无症状患者；有症状的患者被排除。术前计算NAR，方法是中性粒细胞计数除以血清白蛋白。还分析了其他炎症标志物，如中性粒细胞与淋巴细胞比值（NLR）以及C反应蛋白（CRP）与白蛋白比值（CAR）。
在接受DSA的患者中，有191例检测到重度颈动脉狭窄。重度颈动脉狭窄组的个体年龄更大，糖尿病和高血压的患病率更高（分别为51（45 - 57）对60（54 - 68），<0.001；143对83，=0.025；193对104，=0.021），中性粒细胞计数也更高（4.3（3.2 - 6.2）对8.1（4.9 - 12.5），<0.001），NLR（2.2（1.4 - 3.2）对4.2（2.3 - 8.9），<0.001），而CRP（3.8（1.8 - 8）对5.7（3.6 - 7.），=0.005）和CAR（0.9（0.5 - 1.9）对1.6（0.8 - 2.1），<0.001）值显著更高。重度颈动脉狭窄组患者的NAR高于非重度组（1.1（0.8 - 1.6）对2.1（1.4 - 3.2）），<0.001）。多因素分析确定NAR是颈动脉狭窄的独立预测因子（比值比[OR]：3.432；95%置信区间[CI]：2.116 - 5.566；<0.001）。预测重度颈动脉狭窄的NAR最佳截断值为1.47，其敏感性为73.8%，特异性为70.5%。
NAR可通过简单的血液检测轻松测量，在预测重度颈动脉狭窄方面显示出中等的敏感性和特异性，表明其在临床风险评估中作为辅助标志物的潜在作用。
