腹型肥胖成人患者内脏脂肪分布与冠状动脉损伤的关系

Relationship between visceral fat distribution and coronary damage in abdominal obesity adults

目的探讨成人腹型肥胖患者内脏脂肪分布特征及与冠状动脉损伤的关系。方法 57例疑似冠心病(coronary heart disease,CHD)的腹型肥胖患者,依据冠状动脉造影检查结果分为CHD组41例和非CHD组16例。采用ELISA法检测2组血脂水平,行64排螺旋CT检查评估腹部内脏脂肪组织、心外膜脂肪组织、腹部总脂肪组织、冠状动脉周围脂肪厚度、胸主动脉周围脂肪组织、腹主动脉周围脂肪组织等,多因素logistic回归分析冠状动脉损伤的影响因素。结果CHD组年龄[(57.09±9.86)岁]、高血压比率(58.54%)、胱抑素C水平[(1.08±0.25)mg/L]、心外膜脂肪组织体积[(204.49±65.86)cm^3]、冠状动脉周围脂肪厚度[(14.90±2.28)mm]、右心室游离壁脂肪厚度[(6.96±1.43)mm]、胸主动脉周围脂肪组织体积[(20.65±6.40)cm^3]、腹主动脉周围脂肪组织体积[(56.45±20.29)cm^3]均高于非CHD组[(43.12±8.51)岁、25.00%、(0.86±0.11)mg/L、(129.14±52.19)cm^3、(10.89±2.11)mm、(4.06±1.30)mm、(13.08±3.81)cm^3、(44.29±11.29)cm^3](P<0.05),2组体质量指数、腰臀比、低密度脂蛋白胆固醇等比较差异均无统计学意义(P>0.05);多因素logistic回归分析结果显示,心外膜脂肪组织体积增大(OR=1.060,95%CI:1.001~1.116,P=0.047)、冠状动脉周围脂肪厚度增加(OR=4.170,95%CI:1.038~16.766,P=0.044)是腹型肥胖成人患者发生冠状动脉损伤的危险因素。结论腹型肥胖成人患者中,不同部位脂肪组织对冠状动脉损伤的作用存在差异;心外膜脂肪组织体积增大及冠状动脉周围脂肪厚度增加可能是冠状动脉损伤的危险因素。

Objective To explore the relationship between visceral fat distribution and coronary damage in abdominal obesity adults. Methods Fifty-seven suspected coronary heart disease （CHD） patients with abdominal obesity were divided into CHD group （n=41） and non-CHD group （n= 16） according to coronary angiography results. The blood lipid levels were detected by ELISA method. The abdominal visceral adipose tissue, epicardial adipose tissue, total abdominal adipose tissue, peripheral coronary artery fat thickness, thoracic peri-aortie adipose tissue and abdominal peri-aortie adipose tissue were assessed by 64-slice CT. Multivariate logistic regression analysis was used to study the influencing factors for coronary damage. Results The age （ （57.09 ± 9.86） years）, hypertension （58.54 % ） , cystatin C （ （ 1.08 ± 0.25） rag/L）, epicardial adipose tissue volume （（204.49±65.86） cm^3 ）, pericoronary adipose tissue thickness （（14.90±2.28） ram）, right ventricular free wall fat thickness （（6. 96±1. 43） cm）, thoracic peri-aortic adipose tissue volume （（20.65!6. 40） mm3） and abdominal peri-aortic adipose tissue volume （（56.45 ±6. 20. 29） cm^3） in CHD group were significantly high than those in nonCHD group （（43. 12-~8. 51） years, 25.00^%, （0. 86±0. 11） rag/L, （129. 14± 52.19） cm^3, （10.89±2.11）mm, （4.06±1.30） mm, （13.08-＋3.81） cm3, （44.29_＋11.29） cm3） （P〈0. 05）, and there were no signijicant differences in body mass index, waist-to-hip ratio and low-density lipoprotein cholesterol between two groups （P〈0. 05）. Multivariate logistic regression analysis showed that increased epicardial adipose tissue volume （OR=I. 060, 95% CI： 1. 001-1. 116, P= 0. 047） and pericoronary adipose tissue thickness （OR = 4. 170, 95% CI： 1. 038-16. 766, P=0. 044） were the risk factors for coronary damage. Conclnsion Fat accumulation in different parts of the body has different influence on coronary damage in adult patients with abdominal obesity, and increased epicardal adipose tissue volume and pericoronary adipose tissue thickness are probably the risk factors for coronary damage.