慢性肾脏病患者心外膜脂肪体积与生化、炎症指标的相关性研究

The relationship between epicardial fat volume and changes of biochemical and inflammatory indices in chronic kidney disease patients

目的研究慢性肾脏病(chronic kidney disease,CKD)患者心外膜脂肪体积(epicardial fat volume,EFV)与生化、炎症等临床血清学指标的关系。方法将30例查体中心的健康人作为对照组,120例慢性肾脏病(CKD3、4、5、5D期)患者作为患者组,通过AW4.3工作站的Volume软件手动逐层追踪心脏,获得心外膜脂肪体积(EFV),同时检测其他血清学指标,测定血白蛋白、血肌酐、血钙、血磷、碱性磷酸酶(alkaline phosphatase,ALP)、空腹血糖、全段甲状旁腺激素(intact parathyroid hormone,i PTH)、超敏C反应蛋白(high-sensitivity C-reactive protein,hs-CRP)、高密度脂蛋白胆固醇(high density lipoprotein cholesterol,HDL-C)、低密度脂蛋白胆固醇(low density lipoprotein cholesterin,LDL-C),收集年龄、体质量指数(body mass index,BMI),分析慢性肾脏病患者心外膜脂肪体积与血清学指标之间的关系。结果 (1)CKD4、5和5D期组的患者心外膜脂肪体积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]。(2)相关性分析显示:在患者组各期患者中,心外膜脂肪与血肌酐呈正相关(r=0.675,P=0.006;r=0.512,P=0.043;r=0.794,P=0.011;r=0.449,P=0.013);在CKD4期、5期和5D期患者组中,EFV与血磷呈正相关(r=0.556,P=0.025;r=0.713,P=0.031;r=0.417,P=0.022);在CKD4期、5期及5D期中,EFV与i PTH呈正相关(r=0.510,P=0.044;r=0.811,P=0.001;r=0.399,P=0.032);CKD3、4、5及5D期患者的EFV与年龄(r=0.292,P=0.005;r=0.605,P=0.013;r=0.502,P=0.008;r=0.662,P=0.005)、hs-CRP(r=0.723,P=0.005;r=0.604,P=0.022;r=0.593,P=0.020;r=0.574,P=0.005)呈正相关;CKD3、4、5及5D期患者的EFV与HDL-C呈负相关(r=-0.625,P=0.013;r=-0.608,P=0.012;r=-0.679,P=0.005;r=-0.433,P=0.024);CKD 4、5及5D期患者的EFV与体质量指数呈正相关(r=0.256,P=0.026;r=0.521,P=0.046;r=0.648,P=0.009)。(3)多元线性回归分析示:EFV与年龄(β=0.250,P=0.005)、BMI(β=0.192,P=0.020)、血磷(β=0.309,P<0.001)、HDL(β=-0.335,P<0.001)、hs-CRP(β=0.186,P=0.023)显著相关。结论在慢性肾脏病患者中,心外膜脂肪体积可以作为慢性肾脏病合并矿物质与骨代谢紊乱患者钙化进展的非侵袭性早期预测指标。

Objective To evaluate whether epicardial fat volume （EFV） is related to biochemical and in-flammatory indices in chronic kidney disease （CKD） patients. Method A total of 30 healthy people from medical checkup center as the control group and 120 CKD patients were subjected to heart scanning by multi-slice computed tomography. Cross-sectional tomographic cardiac slices from base to apex were traced semi-automatically using a volume viewer of AW4.3 off-line workstation. EFV was measured by assigning Houn-sfield units ranging from-30 to-250 for fat. Serological indicators including serum albumin, creatinine （Scr）, calcium, phosphorus （P）, alkaline phosphatase, fasting glucose, parathyroid hormone （iPTH）, high-sensitivity C-reactive protein （hs-CRP）, high density lipoprotein （HDL） and low density lipoprotein （LDL） were mea-sured. Age and body mass index （BMI） were collected. The relationship between EFV and changes of bio-chemical and inflammatory indices was then analyzed in CKD patients. Results ①EFV was apparently high-er in CKD patients at stage 4, 5 and 5D compared with the control group （140.03 ＆#177; 54.71, 145.01 ＆#177; 64.56, 141.45＆#177;62.04 and 92.42＆#177;39.56 cm3 for stage 4, 5 and 5D CKD patients and healthy controls, respectively;P=0.007, 0.015 and 0.001 compared with control for stage 4, 5 and 5D patients, respectively）. ②In CKD pa-tients at stage 3, 4, 5, and 5D, EFV was positively correlated with Scr, hs-CRP and age （for Scr：r=0.675, P=0.006;r=0.512, P=0.043;r=0.794, P=0.011;r=0.449, P=0.013;for hs-CRP：r=0.723, P=0.005;r=0.604, P=0.022;r=0.593, P=0.020;r=0.574, P=0.005;for age：r=0.292, P=0.005;r=0.605, P=0.013;r=0.502, P=0.008;r=0.662, P=0.005）, and was negatively correlated with HDL （r=-0.625, P=0.013; r=-0.608, P=0.012; r=-0.679, P=0.005; r=-0.433, P=0.024）. In CKD patients at stage 4, 5 and 5D, EFV was positively correlated with P, iPTH and BMI （for P：r=0.556, P=0.025;r=0.713, P=0.031;r=0.417, P=0.022;for iPTH：r=0.510, P=0.044; r=0.811, P=0.001; r=0.399, P=0.032; for BMI： r=0.256, P=0.026; r=0.521, P=0.046; r=0.648, P=0.009）. （c） Multiple linear regression showed that EFV was significantly correlated with age （β=0.250, P=0.005）, BMI （β=0.192, P=0.020）, P （β=0.309, P〈0.001）, HDL （β=-0.335, P〈0.001） and hs-CRP （β=0.186, P=0.023）. Conclusions Measurement of EFV may provide a useful and noninvasive indicator for coronary artery calcification in CKD patients with mineral and bone disorder.