心外膜脂肪组织体积与原发性高血压合并冠心病的相关性  

Correlation study of epicardial adipose tissue volume and essential hypertension with coronary heart disease

作　　者：王亚柱 郭云飞 司月乔 刘超[1] 张英[1] Wang Yazhu;Guo Yunfei;Si Yueqiao;Liu Chao;Zhang Ying(Department of Cardiology,Affiliated Hospital of Chengde Medical University,Chengde 067000,China;Department of Anesthesia, Affiliated Hospital of Chengde Medical University, Chengde 067000, China)

机构地区：[1]承德医学院附属医院心内科,河北承德067000 [2]承德医学院附属医院麻醉科,河北承德067000

出　　处：《临床荟萃》2021年第8期699-703,共5页Clinical Focus

基　　金：河北省科学技术厅指令性计划项目心表面脂肪炎症影像学检查、炎性因子水平与冠心病的诊断及预后评价(17277769D)。

摘　　要：目的探讨心外膜脂肪组织(EAT)体积与原发性高血压(EH)合并冠心病(CHD)的关系,并评价EAT体积对EH合并CHD的致病风险及预测价值。方法连续入选2014年12月-2017年6月于承德医学院附属医院心内科拟诊为稳定性CHD并行冠状动脉CT血管造影(CCTA)检查的EH患者408例,依据CCTA的结果将诊断CHD的患者设为研究组(n=319),非CHD患者设为对照组(n=89);比较两组临床基线资料及EAT体积的差异;受试者工作特征(ROC)曲线评估EAT体积对EH合并CHD的诊断价值,并确定最佳诊断界值;Logistic回归分析EH合并CHD的危险因素;Spearman相关性分析EAT体积与Gensini评分及冠状动脉钙化积分(CACS)的相关性。结果研究组EAT体积高于对照组(P<0.05);ROC曲线分析显示,EAT体积诊断EH合并CHD的曲线下面积(AUC)为0.698(P<0.05),当EAT体积取最佳诊断界值为172.5 cm3时,诊断EH合并CHD效能最高,敏感度和特异度分别为42.7%和94.3%;多因素Logistic回归分析显示,EAT体积≥172.5 cm3为EH合并CHD的独立危险因素(P<0.05),相对危险度为10.050(3.459~29.204);Spearman相关性分析显示,EAT体积与Gensini评分及CACS呈正相关(r=0.207、0.235,P<0.05)。结论CCTA测量EAT体积可作为临床诊断EH合并CHD的无创辅助检查手段;EAT体积与EH患者的Gensini评分及CACS呈正相关,高EAT体积是EH合并CHD的独立危险因素。Objective To explore the relationship between epicardial adipose tissue(EAT)volume and essential hypertension(EH)with coronary heart disease(CHD)for its pathogenic risk and predictive value.Methods The study involved 408 patients with EH who underwent coronary computed tomographic angiography(CCTA)from December 2014 to June 2017 in our hospital.The patients were divided into study group(n=319)and control group(n=89)by CCTA diagnosis of CHD and non-CHD.The differences in terms of clinical baseline characteristics and EAT volume between two groups were compared.Receiver operating characteristic(ROC)curve were used to assess the diagnostic value of EAT volume for EH with CHD and to determine the optimal cut-off value.Logistic regression analysis to assess risk factors for combined CHD in EH.EAT volume with Gensini score and coronary artery calcification score(CACS)were evaluated with Spearman correlation analysis.Results The EAT volume was higher in CHD group than in non-CHD group(P<0.05).ROC curve analysis showed that the AUC of EAT volume in diagnosing EH combined CHD was 0.698(P<0.05).When the truncation value of EAT volume was 172.5 cm3,the diagnostic EH concurrent CHD was most effective,with the sensitivity and specificity of 42.7%and 94.3%.Multi-factor logistic regression analysis showed that EAT volume≥172.5 cm3 was independent risk factors for EH combined with CHD(P<0.05),the relative hazard level was 10.050(3.459-29.204).Spearman correlation analysis showed that EAT volume was positively correlated with Gensini scores and CACS(r=0.207,0.235,P<0.05).Conclusion Measurement of EAT volume by CCTA may be a new clinical non-invasive diagnostic tool for EH with CHD.EAT volume was positively correlated with Gensini score and CACS in patients with EH.High EAT volume was an independent risk factor for EH with CHD.

关 键 词：冠状动脉疾病 心外膜标测 高血压 危险因素 诊断 

分 类 号：R541.4[医药卫生—心血管疾病]