心外膜脂肪组织容积与冠心病介入治疗患者临床预后的关系  

Relationship between epicardial adipose tissue and clinical prognosis of patients with coronary heartdisease after percutaneous coronary intervention

作　　者：张彦月 李旭[2] 林文华[1] 刘菁晶[1] 敬锐[1] 卢宇杰[1] 邸成业[1] 史宏岩[1] 高鹏[1] 

机构地区：[1]泰达国际心血管病医院内一科,天津300457 [2]泰达国际心血管病医院放射科,天津300457

出　　处：《中华医学杂志》2018年第3期208-212,共5页National Medical Journal of China

基　　金：天津滨海新区卫生局科技项目联合攻关（YJ-KY-Linwh01-201403）

摘　　要：目的评估心外膜脂肪组织容积（EATV）在冠心病患者中的临床预后价值。方法前瞻性入选2013年7月至2016年7月在泰达国际心血管病医院接受冠状动脉介入治疗的冠心病患者474例，测量心外膜脂肪组织容积，根据测量的容积结果分为A组（EATV≤75m1），B组（75ml〈EATV〈150m1），C组（EATV≥150m1），分别测量三组患者体质指数（BMI）、高敏C反应蛋白（hs—CRP）、白细胞介素-6（IL-6）、肿瘤坏死因子．D（TNF—d）的水平，随访三组患者1年内主要不良心血管事件（MACE）发生情况，分析EATV对冠心病介入治疗术后患者MACE预测价值。结果三组患者BMI、hs．CRP、TNF一0【的比较，B组〉A组，c组〉B组，差异具有统计学意义（P〈0．05）；Spearman二变量相关分析显示EATV与hs—CRP，IL-6，TNF—d呈显著正相关（r：0．675～0．700，P〈0．01）。三组患者MACE发生率从高到低依次为C（8．50％）、B（5．26％）、A组（3．13％），差异具有统计学意义（P〈0．01）。受试者工作特征曲线分析显示：EATV水平预测MACE事件发生的曲线下面积为0．751（95％C10．634～0．868，P〈0．01），以120．39ml为诊断截点，预测MACE事件的敏感度和特异度分别为72．7％及61％，可以作为预测MACE发生率的独立危险因素。结论EATV水平与冠心病介入治疗术后患者发生MACE密切相关，EATV〉120．39ml是冠心病介入治疗术后发生MACE的独立危险因素。Objective To further evaluate the clinical value of epicardial adipose tissue volume （EATV） in predicting the prognosis of coronary heart disease （CHD） after percutaneous coronary intervention （PCI）. Methods From July 2013 to July 2016 in TEDA International Cardiovascular Disease Hospital, a total of 474 patients diagnosed with CHD were included in this study. According to the result of EATV, patients were divided into three groups, group A （ EATV ~〈 75 ml）, group B （ 75 ml 〈 EATV 〈 150 ml）, and group C （EATV ~〉 150 ml）. Then the level of body mass index （BMI）, hypersensitive c- reactive protein （hs-CRP）, interleukin （IL）-6 and tumor necrosis factor （TNF）-a were tested for all the three groups. All the patients were followed up for 1 year for major adverse cardiovascular events （MACE）. The clinical value of EATV in predicting the occurrence of MACE events was evaluated. Results The BMI, level of hs-CRP, TNF-a in group B were higher than group A, group C were significantly higher than group B, with statistically significant difference across all the comparisons （ P 〈 0. 05 ）. Spearman correlation analysis showed EATV was positively correlated with hs-CRP, IL-6, TNF-a（ r = 0. 675 - 0. 700, P 〈 0. 01 ）. The incidence of MACE in the three groups were 8. 50% in group C, 5.26% in group B, 3.13% in group A, and the differences were all significant （P 〈0. 01 ）. ROC curve showed the cut-off value of EATV levelwas 120. 39 ml to predict MACE （area under cure：0. 751, 95% CI：O. 634 - 0. 868, P 〈 0.01 ）, and the sensitivity was 72.7%, the specificity was 61%. EATV 〉 120. 39 ml can be used as an independent risk factor for predicting the occurrence of MACE. Conclusion The level of EATV is closely related to the occurrence of MACE events, and EATV 〉 120. 39 ml is an independent risk factor for MACE in patients with CHD after PCI.

关 键 词：冠状动脉疾病 经皮冠状动脉介入治疗 心外膜脂肪组织 主要不良心血管事件 

分 类 号：R541.4[医药卫生—心血管疾病]