天津医药

天津医药 ›› 2018, Vol. 46 ›› Issue (10): 1079-1083.doi: 10.11958/20171489

• 临床研究 • 上一篇    下一篇

心外膜脂肪组织体积与冠状动脉粥样硬化严重程度及预后的关系

沈蕾，李晓惠，廖敏蕾△   

  1. 基金项目：宝山区卫生和计划生育委员会科研课题资助项目［BSIK-2014-A02（01）］ 作者单位：上海第一人民医院宝山分院心内科（邮编200940） 作者简介：沈蕾（1980），女，本科，主治医师，主要从事冠心病的治疗研究 △通讯作者 E-mail: lml1970@aliyun.com
  • 收稿日期:2017-12-22 修回日期:2018-07-28 出版日期:2018-10-15 发布日期:2018-11-09
  • 通讯作者: 沈蕾 E-mail:shenlei1980@aliyun.com
  • 基金资助:
    宝山区卫生和计划生育委员会科研课题

Correlation between epicardial adipose tissue volume and the severity and prognosis of coronary atherosclerosis

SHEN Lei，LI Xiao-hui，LIAO Min-lei△   

  1. Department of Cardiovascular Medicine, Baoshan Branch of Shanghai First People’s Hospital，Shanghai 200940, China △Corresponding Author E-mail:lml1970@aliyun.com
  • Received:2017-12-22 Revised:2018-07-28 Published:2018-10-15 Online:2018-11-09

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摘要： 摘要：目的 探讨心外膜脂肪组织体积（EATV）与冠状动脉粥样硬化严重程度及预后的关系。方法 选取接受 经皮冠状动脉介入治疗（PCI）患者（冠心病组）170例及未发现冠状动脉狭窄（非冠心病组）患者58例，分析2组患者 临床资料差异。采用Gensini积分系统将冠心病组患者分为低分组（108例）、中分组（30例）和高分组（32例），计算患 者EATV，评估各组临床资料的差异，Pearson相关分析EATV与患者Gensini评分、病变血管数量的相关性。患者PCI 术后1年进行随访，观察有无新出现的冠脉病变进展，应用受试者工作特征（ROC）曲线评估EATV对PCI术后冠脉新 发病变的预测价值。结果 冠心病组体质量指数（BMI）、原发性疾病（高血压和糖尿病）比例、三酰甘油（TG）、低密度 脂蛋白（LDL-C）和EATV均高于非冠心病组（P＜0.05）；Gensini评分低、中、高分组间LDL-C和EATV差异有统计学 意义（P＜0.05），其中高分组LDL-C和EATV水平高于低分组和中分组（P＜0.05）。3组间病变血管数量差异有统计 意义（P＜0.05）。EATV 与 Gensini 评分呈正相关（r=0.853，P＜0.05），病变血管数量与 EATV 关系为三支及以上病 变＞二支病变＞单支病变（P＜0.05）。PCI术后1年冠脉新发病变发生率10%，该部分患者EATV高于无新发冠脉病 变的患者（P＜0.05），EATV预测冠脉新发病变的ROC曲线下面积为0.626（95%CI：0.512～0.740），敏感度88.2%，特 异度40.5%，EATV最佳截断值124.70 cm3。结论 EATV与冠状动脉硬化的严重程度呈正相关，可作为诊断及预后 的参考指标，当EATV大于124.70 cm3时，患者PCI术后1年内新发血管病变风险增加。

关键词: 冠心病, 预后, 心外膜脂肪体积, Gensini评分

Abstract: Abstract: Objective To investigate the relationship between epicardial adipose volume (EATV) and the severity and prognosis of coronary atherosclerosis. Methods The clinical data of 170 patients underwent percutaneous coronary intervention (PCI) and 58 patients without coronary artery stenosis were analyzed. Patients who accepted PCI were divided into low score group (n=108), middle score group (n=30) and high score group (n=32) according to Gensini score system. Data of EATV were evaluated. The differences in clinical data were analyzed between groups. Gensini scores and the number of diseased vessels in patients were observed by Pearson’s method, and receiver operating characteristic curve (ROC) were used to evaluate the value of EATV in the prognosis of PCI. Results The body mass index (BMI), primary diseases (hypertension and diabetes), triglyceride (TG), low density lipoprotein (LDL-C) and EATV were significantly higher in the coronary heart disease patients than those of patients with non-coronary heart disease (P＜0.05). There were significant differences in LDL-C and EATV between the low, middle, and high Gensini groups (P＜0.05), in which the LDL-C level and EATV level were significantly higher in high Gensini group than those of other two groups (P＜0.05). There were significant differences in the number of diseased vessels between three groups (P＜0.05). EATV was positively correlated with Gensini score (r=0.853, P＜0.05). The relationship between the number of diseased vessels and EATV was three or more lesions>two-vessel disease>single-vessel disease (P＜0.05). One years after PCI, the incidence of new coronary artery lesions was 10%. EATV was higher in these patients than that of patients without new coronary artery disease (P＜0.05). The area under the ROC curve was 0.626 (95% CI: 0.512 - 0.740), the sensitivity was 88.2%, the specificity was 40.5%, and cutoff value was 124.70 cm3. Conclusion EATV is positively correlated with the severity of coronary arteriosclerosis, which can be used as a reference for diagnosis. When EATV is greater than 124.70 cm3 the incidence of neovascularization increases in patients within 1 year after PCI.

Key words: coronary disease, prognosis, epicardium adipose tissue volume, gensini score