心外膜脂肪定量及其炎症状态与冠状动脉粥样硬化斑块易损性的关系  

Association of human epicardial adipose tissue volume and inflammatory mediators with atherosclerosis and vulnerable coronary atherosclerotic plaque

作　　者：周亮亮[1] 宫剑滨[1] 李德闽[2] 卢光明[3] 陈栋[1] 王璟[1] 

机构地区：[1]南京大学医学院临床学院南京军区南京总医院心脏内科,210002 [2]南京大学医学院临床学院南京军区南京总医院心胸外科,210002 [3]南京大学医学院临床学院南京军区南京总医院医学影像,210002

出　　处：《中华心血管病杂志》2015年第2期134-140,共7页Chinese Journal of Cardiology

基　　金：南京军区医学科技创新重点课题（092026）;江苏省“六大人才高峰”资助项目（WS-078）;南京军区南京总医院青年基金课题（2009Q003）

摘　　要：目的 评估心外膜脂肪体积（EATV）及心外膜脂肪局部分泌的炎症因子水平与冠状动脉粥样硬化斑块易损性的关系.方法 260例患者行64排双源CT评估冠状动脉狭窄程度并测定EATV,同期行外周血脂肪因子、胰岛素抵抗指数等检测.其中180例经DSA造影确诊冠心病,80例（包含40例瓣膜病术前检查病例）排除明显冠状动脉狭窄为对照组.180例冠心病患者经CTA图像测定斑块重构指数、脂质体积、钙化体积及纤维体积,并分析其与EATV的相关性.180例冠心病患者中40例接受冠状动脉旁路移植术（CABG）,采集心外膜、胸腔内脂肪组织,分别用RT-PCR和Western blot法检测瘦素、基质金属蛋白酶9（MMP-9）的mRNA和蛋白表达水平.结果 （1）冠心病组EATV明显高于非冠心病组[（121.2 ±40.6）mm3比（74.7 ±18.1）mm3,P=0.01].（2）冠心病组内分析显示,血管正性重构患者（n=80）的EATV明显高于无重构及负重构患者（n=100）[（97.6±42.0） cm3比（75.5 ±25.4）cm3,P=0.01];脂质体积与EATV呈明显正相关（r=0.34,P=0.002）,而斑块纤维体积与EATV呈负相关（r=-0.30,P=0.008）.（3）logistic回归分析显示EATV是影响正性重构的独立危险因素（OR =2.01,95％ CI：1.30～2.32,P=0.01）.（4）行CABG术的40例冠心病患者与40例非冠心病患者比较,心外膜脂肪瘦素、MMP9mRNA和蛋白的表达以及免疫活性均较高（P＜0.01）,胸腔内脂肪瘦素、MMP9mRNA和蛋白的表达差异无统计学意义（P＞0.05）.（5）冠心病患者心外膜脂肪瘦素、MMP9水平及EATV与斑块脂质体积、纤维体积均呈正相关（P均＜0.05）.结论 EATV与冠心病斑块易损性指标相关,且独立于其他传统危险因素;冠心病患者心外膜炎症因子分泌量较非冠心病患者及胸廓内脂肪显著增加,心外膜炎症因子分泌量与EATV呈正相关,两者均是影响血管正性重构的因素.控制心外膜脂肪数量的增加及炎症状态将有助于降�Objective To investigate the relation of epicardial adipose tissue volume （EATV） determined by dual-source CT（DSCT） cardiac angiography and EAT-derived inflammatory factors to coronary heart disease （CHD） and vulnerable plaque.Methods A total of 260 patients underwent cardiac computed tomography to evaluate stenosis of coronary artery,and blood samples were obtained from each patient.CHD was confirmed in 180 patients by DSA and CHD was excluded in the remaining 80 patients （NCHD）.Vascular remodeling index and plaque vulnerability parameters （fatty volume,fibrous volume and calcification volume and fiber volume） were measured in CHD patients and correlation with EATV was analyzed.Epicardial adipose tissue （EAT） and intrathoracic adipose tissue （TAT） were collected from 40 CHD patients undergoing CABG surgery,and,mRNA and protein expressions of leptin and MMP9 were detected by RT-PCR and Western blot analysis.Results （1） The EATV was significantly higher in the C HD group than in NCHD group （（121.2 ± 40.6） mm3 vs.（74.7 ± 18.1） mm3,P =0.01）.（2） Subgroup analysis of the CHD patients demonstrated that EATV was significantly higher in patients with positive remodeling than in patients without positive remodeling （（97.6 ± 42.0） cm3 vs.（75.5 ± 25.4） cm3,P =0.01）.Lipid plaque volume was positively correlated with EATV （r =0.34,P =0.002） ; however,fiber plaque volume was negatively correlated with EATV （r =-0.30,P =0.008）.（3） Logistic regression analysis indicated that EATV was an independent risk factor for positive vascular remodeling（OR =2.01,95% CI：1.30-2.32,P =0.01）.（4） mRNA and protein expression of leptin and MMP9 in EAT was significantly upregulated in 40 CHD patients who received CABG surgery compared to 40 NCHD patients （P 〈 0.01）.However,there was no significant difference （P 〉 0.05） in mRNA and protein expression of leptin and MMP9 from the SAT between CHD and NCHD patients.（5） In the CHD group,leptin and MMP9

关 键 词：动脉粥样硬化 基质金属蛋白酶 瘦素 心外膜脂肪 

分 类 号：R543.3[医药卫生—心血管疾病]