双源CT心外膜脂肪体积定量对冠状动脉斑块稳定性的影响

Impact of epicardial adipose tissue volume on coronary atherosclerotic plaques stability assessed by computed tomographic coronary angiography

目的探讨冠心病患者心外膜脂肪体积对冠状动脉斑块稳定性的影响。方法纳入同期行双源CT冠状动脉成像与经皮冠状动脉造影的冠心病患者145例,测量患者的身高、体重、血压、血生化指标,通过64排双源CT测定心外膜脂肪体积与斑块性质、重构指数、点状钙化,并进行心外膜脂肪体积与易损斑块的相关分析。结果年龄、性别、吸烟、糖尿病、总胆固醇(TC)、低密度脂蛋白胆固醇(LDL-C)、高密度脂蛋白胆固醇(HDL-C)、甘油三酯(TG)在斑块性质、血管重构、点状钙化中的差异均无统计学意义(P>0.05)。LDL-C在斑块性质与点状钙化中也无统计学差异(P>0.05),正性重构组LDL-C水平高于非正性重构组(P=0.040)。非钙化斑块组、正性重构组、点状钙化组的高血压患病率、BMI与心外膜脂肪体积均高于钙化斑块组、非正性重构组、无点状钙化组(P<0.05),其中心外膜脂肪体积差异最大(P<0.001)。Logistic回归分析表明心外膜脂肪体积是影响易损斑块的独立危险因素(OR=2.015,P=0.001)。ROC曲线分析表明心外膜脂肪体积诊断易损斑块的阈值为103.7 cm3,诊断的敏感性与特异性分别为93.0%和61.8%(P<0.001)。结论双源CT测量心外膜脂肪体积与冠状动脉粥样硬化斑块的斑块性质、血管重构、点状钙化具有良好的相关性,可作为影响易损斑块的独立危险因素,并早期判断冠心病患者的预后。

Objective To investigate whether epicardial adipose tissue （EAT） volume is related to coronary plaques stability in patients with coronary artery disease （CAD）. Methods A total of 145 coronary heart disease patients who underwent dual-source 64-slice CT and percutaneous coronary angiography were included for this study. Each patients was taken the measurements of height, weight, BP and blood biochemical parameters. We evaluated all patients referred for 64-slice CT, and assessed EAT volume and vulnerable coronary plaque components-non-calcified plaques （NCPs）, remodeling index （RI） and spotty calcium. The relationship was reviewed between EAT volume and vulnerable coronary plaques. Results There was no statistical difference in age, gender, smoking, DM, TC, HDL-C and TG（P〉0.05）. Hypertension, BMI and EAT volume were higher in NCPs, positive remodeling （PR） and spotty calcium, and there was statistical difference among them （P〈0.05）. The results of Logistic regression analysis showed that EAT volume was an independent predictor of vulnerable coronary plaques （OR=2.015, P=0.001）. The curve of receiver operating characteristic （ROC） indicated that the diagnostic sensitive and specificity of vulnerable coronary plaques were respectively 93.0%and 61.8%when taking EAT volume 103.7 cm3 as threshold value （P〈0.001）. Conclusion EAT volume was associated with the presence of vulnerable plaque components, which was an independent predictor of vulnerable coronary plaques and forecast of CAD patients.