【摘要】 目的探讨CT测量心外膜脂肪组织(epicardial adipose tissue,EAT)体积与冠状动脉粥样硬化的关系。资料与方法 605例临床怀疑冠心病(579例)及冠状动脉支架术后患者(26例)行双源CT冠状动脉造影检查,其中男333例,女272例,年龄22～87岁,平均(60.1±12.5)岁。利用工作站软件测量每例心脏EAT体积,同时观察冠状动脉是否发生病变、病变程度(包括冠状动脉病变支数、钙化积分程度、冠状动脉狭窄程度)、斑块性质(分为无斑、软斑、钙斑、混斑)、有无壁冠状动脉,记录体重指数(body mass index,BMI)及有无相关疾病(如高血压、高血脂、高血糖等),分析EAT体积与BMI及冠状动脉病变的相关性。结果 EAT体积与BMI呈正相关(rs=0.504,P<0.001)。所有病例总体分析,有、无粥样硬化两组EAT体积差异有统计学意义,无病变组低于有病变组(Z=-4.839,P<0.001)。患相关疾病者中有、无粥样硬化两组EAT体积的差异有统计学意义,无冠状动脉病变组低于有冠状动脉病变组(Z=-2.885,P=0.004)。分别对BMI<24、≥24及<30的病例按有、无粥样硬化分组比较EAT体积差异,均显示EAT体积无病变组低于有病变组(Z=-3.714,P<0.001;Z=-3.53,P<0.001;Z=-4.871,P<0.001);但BMI≥30的28例中,冠状动脉有、无病变组EAT体积差异却无统计学意义(Z=-0.024,P=1)。进一步对BMI<30的病例行冠状动脉患病风险评估计算得出,EAT体积>147.13 mm3则患病风险高;EAT体积与冠状动脉病变严重程度的相关性分析显示,EAT体积与右冠状动脉、左主干、左前降及左旋支的狭窄程度均无相关。EAT体积与钙化积分程度呈正相关(rs=0.146,P<0.001)。EAT体积与冠状动脉粥样硬化支数呈正相关(rs=0.209,P<0.001)。不同性质斑块心外膜脂肪量不同(χ2=21.288,P<0.001);进一步两两比较,无斑块组低于软斑组(P=0.002);无斑块组低于混斑组(P<0.001);其他无差别。分别对有、无粥样硬化病例按是否出现壁冠状动脉分组,分析两组间EAT体积差异,结果显示无论有无粥样硬化,有、无壁冠状动脉两组心外膜脂肪量差异均无统计学意义(Z=-1.022,P=0.307;Z=-0.267,P=0.79)。结论 CT测量EAT体积与BMI呈正相关;对于非肥胖者,EAT体积是冠状动脉粥样硬化发病危险性的独立预测指标,EAT体积>147.13 mm3者,出现冠状动脉粥样硬化可能性大;EAT体积与冠状动脉病变支数及钙化积分呈正相关,与冠状动脉狭窄程度无相关;带有软斑(包括软斑及混斑)患者EAT体积较大;EAT体积与是否出现壁冠状动脉无关。更多还原

【Abstract】 Objective To explore the relationship between epicardial adipose tissue and coronary artery atherosclerosis with dual source CT.Materials and Methods 579 patients suspected with coronary artery disease and 26 patients with PCI were underwent CT coronary artery angiography,of which male patients were 333,female 272,age 22～87y,average(60.1±12.5).Epicardial adipose tissue(EAT) volume of each subject was semiautomatically calculated on workstation and the coronary artery abnormalities,such as presence of atherosclerosis,severity of atherosclerosis(including number of vessels involved,calcium scoring and degree of stenosis),plaque characteristic(no plaque,soft,calcified and mixed plaque),presence of mural coronary artery were evaluated.Also,body mass index(BMI) and with or without relevent disease(hypertension,diabetes mellitus and hyperlipidemia) were recorded in order to analyze the relation between EAT volume,BMI and coronary artery disease.Results EAT volume was positively correlated with BMI(rs=0.504,P<0.001).In the analysis of all patients,EAT volume in those without atherosclerosis was significantly lower than that of atherosclerotic patients(z=-4.839,P<0.001).Furthermore,in patients with relavent disease,EAT volume in those without atherosclerosis was still lower than that in atherosclerotic subjects(z=-2.885,P=0.004).In patients of BMI<24,≥24 and<30,all those without atherosclerosis had lower EAT volume than that of atherosclerotic patients(z=-3.714,P<0.001;z=-3.53,P<0.001;z=-4.871,P<0.001);but in patients of BMI≥30,no statistical significant difference of EAT volume was found between groups with and without atherosclerosis(z=-0.024,P=1).Furthermore,the subjects with BMI<30 showed high risk for coronary artery atherosclerosis when EAT volume was greater than 147.13 mm3.EAT volume was not correlated with degree of stenosis of RCA,LM,LAD and Cx.But positive correlation was found with regard to number of vessels involved and calcium scoring(rs=0.209,P<0.001;rs=0.146,P<0.001).The EAT volume in no-plaque group was lower than that in soft-palque and mixed-plaque group(P=0.002;P<0.001).Both patients with and without atherosclerosis showed no statistical significance difference of EAT volume between groups with and without mural coronary artery(z=-1.022,P=0.307;z=-0.267,P=0.79).Conclusion EAT volume measured on CT has positively correlated with BMI.For patients of BMI<30,the EAT volume greater than 147.13 mm3 indicated the higher risk of coronary artery atherosclerosis.The EAT volume could be an independent risk predictor of coronary artery atherosclerosis.EAT volume has positively correlated with severity of coronary artery disease(number of vessels involved,calcium scoring)but not correlated with degree of narrowing and mural coronary artery.Patients with soft plaque(soft-plaque and mixed plaque) had higher EAT volume than calcium plaque and no plaque patients did.更多还原