慢性肾脏疾病患者心外膜脂肪体积与冠状动脉钙化的相

Association between epicardial fat volume and coronary artery calcification in patients with chronic kidney disease

目的研究慢性肾脏疾病（CKD）患者心外膜脂肪体积（EFV）与冠状动脉钙化的关系。方法入选2015年10月至2016年3月于青岛市市立医院东院区住院治疗的CKD患者120例，根据肾脏疾病患者生存质量指导（K/DOQI）中关于CKD定义标准进行分期，将入选患者分为4组，即CKD3、4、5和5D期组。另将30名于青岛市市立医院体检中心体检的健康人设为对照组。对入选者进行心脏多层螺旋CT扫描，通过AW4.3工作站的Volume软件手动逐层追踪心脏，设置CT值为－250~－30 HU，获得EFV，通过CaScoring软件对冠状动脉钙化进行量化评分，获得冠状动脉钙化评分（CACS）。同时检测入选者的血清高密度脂蛋白胆固醇（HDL-C）和低密度脂蛋白胆固醇（LDL-C）水平，并收集体重指数、透析方式、糖尿病史和冠心病史。采用Spearman相关分析分析CKD患者EFV与CACS的相关性。结果（1）入选者的基本临床资料：共纳入CKD患者120例和健康对照30例。120例CKD患者中男性73例（年龄32~88岁，平均62.8岁），女性47例（年龄29~91岁，平均66.6岁）。CKD3、4、5和5D期的患者分别有30、28、32和30例，其中维持性腹膜透析者21例，维持性血液透析者9例。CKD伴冠心病的患者88例（73.3%），不伴冠心病的患者32例（26.7%）。CKD伴糖尿病的患者67例（55.8%），不伴有糖尿病的患者53例（44.2%）。（2）各组EFV和CACS的比较结果：CKD4、5和5D期组患者EFV平均值均高于对照组[（140.03±54.71）、（145.01±64.56）和（141.45±62.04） cm3比（92.42±39.56）cm3，P分别为0.007、0.015和0.001]，CKD3期组患者EFV平均值与对照组比较差异无统计学意义[（110.57±59.18）cm3比（92.42±39.56） cm3，P=0.309]。腹膜透析的患者EFV平均值为（144.51±70.09）cm3高于血液透析的患者[（100.95±62.89）cm3，P=0.112]。CKD伴冠心病的患者EFV平均值为（140.67±70.31） cm3，高于不伴冠心病的患者[（105.22±61.49）cm3，P=0.002]。CKD伴糖尿病的患者EFV平均值为（148.41±65.78）cm3高于不伴糖尿病的患者[（110.53±62.37） cm3，P=0.007]。入选CKD患者CACS中位数为140.0分明显高于健康对照人群的4.3分（P〈0.001）。（3）EFV与CACS的相关分析结果：对照组中EFV与CACS相关（rs=0.539，P=0.004），CKD5期组中这种相关性更强（rs=0.841，P〈0.000 1）。且EFV与年龄、体重指数、HDL-C均相关（P均〈0.05），而与eGFR和LDL-C未见相关性。线性相关分析结果显示EFV与CACS相关（r=0.427，R2=0.182 3，P〈0.001）。（4）CACS危险因素的相关性分析结果：CACS与年龄、体重指数呈正相关（P均〈0.05），与eGFR呈负相关（P〈0.05）。

ObjectiveTo evaluate whether epicardial fat volume （EFV） is related to coronary artery calcification in patients with chronic kidney disease（CKD）.MethodMulti-slice computed tomography was performed in 30 healthy subjects and 120 patients with CKD. Cross-sectional tomographic cardiac slices from base to apex were traced semi-automatically using a Volume Viewer of AW4.3 off-line workstation, and EFV was measured by assigning Hounsfield units ranging from -250 to -30 HU to fat.The coronary artery calcification score was assessed by CaScoring software. High density lipoprotein cholesterol（HDL-C）, low density lipoprotein cholesterol（LDL-C） and collecting the body mass index （BMI）, dialysis route, history of diabetes and coronary artery disease were used to analyze the relationship between EFV and other risk factors in patients with CKD.ResultsThere were 60.8%（73/120） male （mean age 62.8 years） and 39.2%（47/120） female （mean age 66.6 years） in the patients cohort, 73.3%（88/120） patients had coronary artery disease, 55.8%（67/120） had diabetes, 21 patients were on peritoneal dialysis and 9 on hemodialysis. EFV was apparently higher in stage 4-5 D CKD group compared with the control group（（140.03±54.71）, （145.01±64.56）and （141.45±62.04） cm3 vs.（92.42±39.56）cm3, P=0.007, 0.015 and 0.001）, was similar between CKD3 and control group, and EFV was significantly higher in peritoneal dialysis group than in hemodialysis group and in coronary artery disease group compared with no coronary artery disease group（（140.67±70.31） cm3 vs.（105.22±61.49） cm3, P=0.002）. EFV was obviously higher in diabetes group than no diabetes group（（148.41±65.78） cm3 vs.（110.53±62.37） cm3, P=0.007）. CACS was apparently increased in stage 3-5 CKD group compared with the control group（140.0 vs.4.3, P〈0.001）. （3）When the patients were divided into four groups according to the eGFR, EFV was positively associated with CACS（rs=0.539, P=0.004） in control group, and the association become more robust in patients with CKD5（rs=0.841, P〈0.000 1）. EFV was related to age（r=0.662, P=0.005）, BMI（r=0.648, P=0.009）and HDL-C（r=-0.433, P=0.024）, but not related to eGFR and LDL-C. EFV was related to CACS（r=0.427, R2=0.182 3, P〈0.001）. CACS was positively correlated to age and BMI （all P〈0.05）and negatively correlated with eGFR（P〈0.05）.ConclusionsMeasurement of EFV may provide another useful noninvasive indicator of coronary artery calcification in CKD patients.