【作者】 彭鹏；

【导师】 葛圣林；

【作者基本信息】 安徽医科大学 ， 外科学（胸心外科）， 2018， 硕士

【摘要】 目的目前关于心外膜脂肪与冠心病之间联系的研究得到愈来愈多的重视,本研究中通过比较正常人和冠心病患者冠状动脉周围的心外膜脂肪CT值以及厚度的差异,初步探讨心外膜脂肪对于冠心病发病的预测价值,并通过分析冠心病患者心外膜脂肪CT值以及厚度与SYNTAX评分之间的相关性,以讨论冠状动脉周围的心外膜脂肪的脂肪CT值以及厚度与冠心病严重及复杂程度之间的关系。方法入选行冠状动脉CT血管造影检查者151例,其中经冠脉造影检查诊断为冠心病者81例,纳入冠心病组,冠脉正常者70例,纳入冠脉正常组,对所有研究的对象临床资料进行回顾性的分析。分析患者冠脉CTA的影像资料,测量冠状动脉周围的心外膜脂肪的CT值以及厚度。对冠心病患者的造影结果进行SYNTAX评分计算,据评分的结果将所有的冠心病患者分成两组:SYNTAX评分低于33分的纳入低积分组,SYNTAX评分33分及以上的纳入高积分组。比较不同组别间的心外膜脂肪CT值以及厚度的差异,并通过线性回归以及多元回归分析冠脉周围心外膜脂肪CT值以及厚度与冠心病的相关性,采用Logistic回归分析分析其对冠心病是否有预测价值。结果冠脉正常组EAT厚度(9.92±1.37mm)低于冠心病组(12.21±2.62mm)(P<0.01),CT值(-70.27±9.79HU)高于冠心病组(-98.38±16.05HU)(P<0.01),冠心病患者中,低积分组EAT厚度(11.73±2.12mm)低于高积分组(14.40±1.54mm)(P<0.01),CT值(-90.06±10.47HU)高于高积分组(-114.13±12.24HU)(P<0.01),经Person相关分析显示,EAT厚度与Syntax评分显著正相关(r=0.857,P<0.01),CT值与Syntax评分显著负相关(r=0.835,P<0.01),经Logistic回归分析,冠状动脉周围心外膜脂的CT值以及厚度对于冠心病有潜在预测价值。结论EAT的脂肪CT值及厚度与冠心病及SYNTAX评分具有显著相关性,对冠心病诊断及病变程度具有潜在预测价值。更多还原

【Abstract】 Objective:The relationship between epicardial fat and coronary heart disease has been paid more and more attention in the academia.In this study,the prediction significance of epicardial fat in the incidence of coronary heart disease was preliminarily discussed by comparing the thickness and CT value of the epicardial fat tissue between nomal people and patients with coronary heart disease.The correlation between thickness and CT value of epicardial fat and SYNTAX score was analyzed in patients with coronary heart disease to demonstrate the relationship between the epicardial fat and the severity of coronary heart disease.Methods:A total of 151 patients underwent CTA examination were selected.81 cases were diagnosed with coronary heart disease according to coronary angiography,embedded in coronary heart disease group.The other 70 patients were embedded in normal coronary artery group.Clinical data of both groups were retrospectively analyzed.Pericoronary EAT thickness and CT value were measured by reviewing medical images.Syntax scores were calculated to evaluated severity of coronary lesions.And we divided all coronary heart disease patients into 2 groups according to SYNTAX scores: low score group(≤32 score),and high score group(≥33 score).Difference of EAT thickness and CT value within all groups were compared.We use multiple regression analysis and multivariate Logistic regression analysis to analyze the correlation between EAT thickness and CT value of EAT and coronary heart disease.Results: Mean thickness of nomal group(9.92±1.37mm)is less than CAD group(12.21±2.62mm),CT value of nomal group(-70.27±9.79HU)is higher than CAD group(-98.38±16.05HU).Mean thickness of low score group(11.73±2.12mm) is lower than high score group(14.40±1.54mm),CT value of low score group(-90.06±10.47HU)is higher than high score group(-114.13±12.24HU).Pearson correlation analysis presents that EAT thickness is significantly correlated with SYNTAX score,and CT value is significantly negatively correlated with the SYNTAX score.Multiple Logistic regression analysis presents that thickness and CT value are independent to coronary heart disease.Conclusions:EAT thickness and CT value demonstrate a significant correlation with SYNTAX scores and existence of coronary artery stenosis,which has potential predictive value for coronary heart disease.更多还原