双源CT测量心周脂肪体积对冠心病的诊断预测价值

Predictive value of dual-source CT determined pericardial adipose tissue in diagnosing coronary artery disease

目的肥胖是代谢综合征和冠状动脉粥样硬化疾病的一个重要危险因素。心周脂肪组织(pericardial adipose tissue,PAT)是沉积在心脏周围,特别是围绕在冠状动脉周围的内脏脂肪组织,可能在冠状动脉粥样硬化的发生中发挥了更为重要的作用。文中通过双源CT(64排)测量PAT体积,评价其对冠心病的诊断预测价值。方法221例同期行双源CT和经皮冠状动脉造影检查的患者入选,进行腰围、体重指数(body mass index,BMI)、空腹血生化测定。使用双源CT测定PAT体积,通过经皮冠状动脉造影检查明确患者的冠心病诊断,采用SPSS 16.0软件进行统计学分析。结果男性的PAT体积明显大于女性(P<0.05),冠心病患者的PAT体积明显大于非冠心病患者(P<0.01)。PAT体积与年龄、性别、BMI、腰围、高血压病、白细胞、高密度脂蛋白胆固醇、低密度脂蛋白胆固醇、纤维蛋白原有高度相关性。Logistic逐步回归分析显示,PAT体积、BMI是影响冠心病发生的独立危险因子。PAT体积诊断冠心病的受试者工作特征(receiver-operating characteristic,ROC)曲线下面积为(72.10±4.4)%(P<0.001),明显优于腰围[(53.8±5.9)%,P=0.487]和BMI[(43.8%±5.8)%,P=0.253]。结论PAT体积与已知的心血管危险因素和冠心病的发生有高度相关性。PAT体积与冠心病的密切程度优于腰围和BMI,可作为一个新的冠心病预测指标。

Objective Obesity is recognized as an important risk factor for the development of all features of metabolic syndrome and atheroselerotic cardiovascular disease. Pericardial adipose tissue （PAT） is true visceral fat deposited around the heart, particularly around subepicardial coronary vessels. PAT may play a more important role in the development of coronary atherosclerosis. The objective of the present study was to evaluate the predictive value of PAT determined by dual-source CT in diagnosing patients with coronary artery disease （CAD）. Methods Two hundred and twenty-one consecutive patients who underwent dual-source （M-slice CT and diagnostic coronary angiography were studied. Each subject was measured for waist circumference, body mass index and blood biochemical index as cardiac parameters. PAT volume was determined by dual-source CT, coronary angiograms were analyzed for the diagnosis of CAD. Results PAT volume was significantly higher in men than that in women （ P 〈 0.05 ）, PAT volume in patients with CAD was significantly higher than that in patients without CAD （P 〈 0.01 ）. A significant correlation was revealed between PAT volume and age, sex, hypertension, waist circumference, body mass index,LDL-C, HLD-C,WBC and fibrinogen, l,ogistic nmhivariate analysis showed that PAT volume, body mass index and hypertension were independent factors affecting the presence of CAD. The area under ROC curve of PAT volume in diagnosis of CAD was 72.10 ±4.4% （ P 〈0. 001 ）. Compared with waist circum（erence and body mass index, PAT volume represent the strongest independent risk factor for the presence of CAD. Conclusion PAT volume was significantly eorrelated with traditional risk factors for the deveh）pment of cardiovascular disease and the presence of CAD, which may be one of the noninvasive ways in predieting CAD.