血浆和心外膜脂肪瘦素水平与冠状动脉粥样硬化斑块性质相关性  

Associations of leptin levels in plasma and epicardial adipose tissue with coronary atherosclerotic plaque

作　　者：周亮亮[1] 邹莺[1] 杭涛[1] 程训民[1] 张启高[1] 陈栋[1] 王强[1] 宫剑滨[1] 王璟[1] 

机构地区：[1]南京军区南京总医院心脏内科,南京210002

出　　处：《中华实用诊断与治疗杂志》2015年第9期858-861,共4页Journal of Chinese Practical Diagnosis and Therapy

基　　金：南京军区医学科技创新重点课题(09Z026);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(2009Q003)

摘　　要：目的探讨血浆及心外膜脂肪局部分泌的瘦素水平与冠状动脉粥样硬化斑块性质的关系。方法疑诊冠心病行64排双源CT冠状动脉造影检查患者260例,入院后行冠状动脉造影检查,其中180例确诊为冠心病(冠心病组),80例排除冠心病(非冠心病组)。冠心病组于CT血管造影图像上测定脂质斑块、钙化斑块及纤维斑块体积;检测2组血浆瘦素、空腹血糖、空腹胰岛素水平,计算胰岛素抵抗指数;采用ELISA法检测2组心外膜和胸腔内脂肪组织瘦素mRNA表达水平,采用Western blot法检测心外膜和胸腔内脂肪组织瘦素蛋白表达水平。结果冠心病组脂质斑块、纤维斑块、钙化斑块体积分别为(14.3±6.3)、(18.2±11.7)、(115.2±54.2)mm3;冠心病组血浆瘦素水平[(15.32±4.02)ng/L]高于非冠心病组[(8.06±5.01)ng/L](P<0.05);冠心病组心外膜脂肪组织瘦素mRNA(15.18±1.92)和蛋白(19.44±10.69)表达水平明显高于非冠心病组(7.01±0.78、10.37±3.19)(P<0.01),2组胸腔内脂肪组织瘦素mRNA和蛋白表达水平差异无统计学意义(P>0.05);冠心病组心外膜瘦素蛋白表达与斑块纤维体积呈负相关(r=-0.35,P=0.008),与脂质斑块体积呈正相关(r=0.48,P=0.002),与钙化斑块体积无明显相关性(r=-0.20,P=0.094);排除血浆瘦素水平影响后,心外膜脂肪局部分泌的瘦素与脂质斑块体积(r=0.46,P=0.003)、纤维斑块体积(r=-0.33,P=0.006)仍呈独立相关性。结论冠心病患者血浆及冠状动脉周围心外膜脂肪中瘦素水平均升高,降低心外膜脂肪局部的炎症状态有助于降低斑块的易损性。Objective To investigate the associations of leptin levels in plasma and epicardial adipose tissue with the features of coronary atherosclerotic plaque. Methods A total of 260 patients with suspected coronary heart disease （CHD） undergoing dual-source 64-slice CT received percutaneous coronary angiography after admission, in which 180 were confirmed CHD （CHD group） and 80 were excluded CHD （non-CHD group）. The plasma leptin level and insulin resistance index were detected in both two groups. The lipid plaque volume, fibrous plaque volume and calcified plaque volume were measured with CT angiography in CHD group. The leptin mRNA level in epicardial adipose tissue was detected with ELISA method and the leptin protein levels in epicardial and thoracic cavity adipose tissue were detected with Western blot. Results The lipid plaque volume was （14.3±6.3） mm3. The fibrous plaque volume was （18.2± 11.7） mm^3, and the calcified plaque volume was （115. 2 ± 54. 2） mm^3 in CHD group. The plasma leptin level was significantly higher in CHD group （（15. 32±4. 02） ng/L） than that in non-CHD group （（8. 06± 5.01） ng/L） （P〈0.05）. Leptin mRNA （15.18±1.92） and protein （19.44±10.69） in epicardial adipose tissue were significantly higher in CHD group than those in non-CHD group （7.01±0.78, 10.37±3.19） （P〈0.01）. There were no significant differences in leptin mRNA and protein in thoracic cavity adipose tissue （P〉0.05）. In CHD group, leptin protein level in epicardial adipose tissue was positively correlated with lipid plaque volume （r=0.48, P= 0. 002）, negatively correlated with fibrous plaque volume （r=-0. 35, P=0.008）, and not correlated with calcified plaque volume （r=-0. 20, P=0.094）. Excluding the influence of plasma leptin, leptin in epieardial adipose tissue was independently correlated with lipid plaque volume （r= 0. 46, P= 0. 003） and fibrous plaque volume （r=- 0.33, P= 0. 006）. Conclusion The leptin levels in plasma and epicardia

关 键 词：冠心病 心外膜脂肪 易损斑块 瘦素 

分 类 号：R541.4[医药卫生—心血管疾病]