Correlation of monocyte/apolipoprotein A1 ratio and carotid plaque in cases with ischemic stroke

YAN Wenyan; ZHANG Lanhai; GUO Weimin; DU Xiaojing; LI Siwen; CUI Haijing; LIU Yin

doi:10.3969/j.issn.1671-2897.2025.06.012

Abstract：Objective To analyze the correlation between monocyte/apolipoprotein A1 ratio(MAR)and carotid plaque in cases with ischemic stroke(CIS).Methods A total of 206 CIS patients admitted to Handan 285 Hospital from December 2021 to October 2024 were selected as the study subjects.According to the stability of carotid artery plaques,they were divided into the stable group(n=88)and the unstable group(n=118).Meanwhile,256 healthy people in Handan 285 Hospital were selected as the control group.All the included subjects were tested for monocyte(M),apolipoprotein A1(ApoA1),and other related indicators,and MAR was calculated.General data and MAR of each group were compared.Spearman analysis was used to analyze the correlation between MAR and carotid plaque instability in CIS cases.The diagnostic value of MAR for carotid plaque instability in CIS cases was evaluated by the ROC curve and area under the curve(AUC)(Bootstrap internal validation).The related factors affecting carotid plaque instability in CIS cases were evaluated by multivariate logistic regression.Results The levels of M and MAR in the peripheral blood of the study group were higher than the control group,while the ApoA1 level was lower than the control group(P<0.05).Unstable group National Institutes of Health Stroke Scale(NIHSS)score,Intima-Media Thickness of the artery,the levels of IMT,peripheral blood monocytes(M),High-sensitivity C-reactive Protein(hs-CRP),and MAR were all higher than those in the stable group,while the level of ApoA1 was lower than that in the stable group(P<0.05).Spearman analysis showed that MAR was positively correlated with carotid plaque instability in CIS cases(r=0.542,P<0.001).The ROC curve results showed that the AUC of MAR for diagnosing carotid plaque instability in CIS patients was 0.902(95%CI:0.852 to 0.952).The corrected AUC verified by Bootstrap was 0.896(95%CI:0.840 to 0.925).NIHSS score≥7.80(OR=1.984),IMT≥1.20mm(OR=2.625),hs-CRP≥3.45mg/L(OR=2.396),and MAR≥0.55(OR=3.789)were all risk factors for carotid plaque instability in CIS cases(P<0.05).Conclusions Abnormally elevated MAR is closely related to carotid plaque instability in CIS patients and can be used as an efficient biological indicator for diagnosing carotid plaque instability.In clinical practice,MAR can be used as an auxiliary screening indicator,combined with indicators such as NIHSS and IMT to assess the risk of carotid plaque instability in CIS patients,which provides a basis for early intervention and treatment.