^(18)F-FDG PET/CT测量的左心房心外膜脂肪炎症活性与心房颤动的相关性  

Association between inflammation activity of left atrial epicardial adipose tissue measured by^(18)F-FDG PET/CT and atrial fibrillation

作　　者：王冰 徐依多 邵山[2] 翟立上 钱波 张飞飞 王建锋[1] 邵晓梁[1] 王跃涛[1] Wang Bing;Xu Yiduo;Shao Shan;Zhai Lishang;Qian Bo;Zhang Feifei;Wang Jianfeng;Shao Xiaoliang;Wang Yuetao(Department of Nuclear Medicine,Third Affiliated Hospital of Soochow University,First People′s Hospital of Changzhou,Changzhou Key Laboratory of Molecular Imaging,Changzhou 213003,China;Department of Cardiology,Third Affiliated Hospital of Soochow University,First People′s Hospital of Changzhou,Changzhou 213003,China)

机构地区：[1]苏州大学附属第三医院,常州市第一人民医院核医学科常州市分子影像重点实验室,213003 [2]苏州大学附属第三医院,常州市第一人民医院心血管内科,213003

出　　处：《中华心血管病杂志》2021年第12期1213-1219,共7页Chinese Journal of Cardiology

基　　金：国家自然科学基金(81871381,81901777)。

摘　　要：目的探讨氟-18-脱氧葡萄糖(^(18)F-FDG)正电子发射型计算机断层扫描(PET/CT)测量的左心房心外膜脂肪(LA-EAT)炎症活性与心房颤动(房颤)的相关性。方法回顾性分析2018年3月至2019年12月因肿瘤指标异常升高或恶性肿瘤于苏州大学附属第三医院核医学科行^(18)F-FDG PET/CT检查的78例房颤患者。按照PET/CT检查日期、年龄、性别等基本特征进行1∶1倾向性评分匹配,设立非房颤对照组(78例)。采用^(18)F-FDG PET/CT测量左心房心外膜脂肪最大标准摄取值(LA-EAT FDG SUVmax)和总EAT体积(V-EAT),超声心动图获得左心室射血分数(LVEF)和左心房内径(LAD),并收集血脂和血炎症指标。比较房颤组和对照组患者临床资料及相关EAT指标的差异;采用多因素logistic回归分析房颤的相关因素;采用受试者工作特征(ROC)曲线及曲线下面积评估LA-EAT FDG SUVmax判断房颤的价值;采用ROC曲线寻找LA-EAT FDG SUVmax判断房颤的最佳界值并据其定义LA-EAT FDG SUVmax增高,单因素和多因素logistic回归分析LA-EAT FDG SUVmax增高与房颤的关系。结果房颤组年龄(66.9±10.2)岁,男性55例(70.5%),对照组年龄(66.9±8.0)岁,男性52例(66.7%),两组的年龄、性别差异均无统计学意义(P均>0.05)。房颤组的LAD[(44.2±5.8)mm比(35.4±4.4)mm]、V-EAT[(122.1±42.0)cm3比(91.6±34.5)cm3]、LA-EAT FDG SUVmax[(1.6±0.3)比(1.4±0.2)]均高于对照组,LVEF[(60.1±4.7)%比(63.9±2.9)%]低于对照组(P均<0.001)。多因素logistic回归分析显示LAD(OR=1.340,95%CI 1.195~1.502)、V-EAT(OR=1.016,95%CI 1.001~1.031)、LA-EAT FDG SUVmax(OR=1.375,95%CI 1.095~1.723)与房颤正相关,LVEF(OR=0.781,95%CI 0.659~0.926)与房颤负相关(P均<0.05)。LA-EAT FDG SUVmax判断房颤的ROC曲线下面积为0.680(95%CI 0.597~0.764,P<0.001),LA-EAT FDG SUVmax判断房颤的最佳界值为1.415(灵敏度为65.4%,特异度为61.5%)。在校正高密度脂蛋白胆固醇、LVEF、LAD、V-EAT后,LA-EAT FDG SUVmax≥1.415与房颤独立相关(OR=2.98Objective To explore the association between inflammation activity of left atrial epicardial adipose tissue(LA-EAT)measured by^(18)F-fluorodeoxyglucose positron emission tomography/computed tomography(^(18)F-FDG PET/CT)and atrial fibrillation(AF).Methods A total of 78 patients with AF,who underwent^(18)F-FDG PET/CT in the Nuclear Medicine Department of the Third Affiliated Hospital of Soochow University due to abnormally elevated levels of tumor indicators or malignant tumors from March 2018 to December 2019,were enrolled in this retrospective study.According to the examination date of PET/CT and basic characteristics of AF patients(gender,age),a 1∶1 propensity score matching was used to enroll a non-AF control group(78 patients).The maximum standard uptake value of left atrial epicardial tissue(LA-EAT FDG SUVmax)and total EAT volume(V-EAT)were measured by^(18)F-FDG PET/CT.Left ventricular ejection fraction(LVEF)and left atrial diameter(LAD)were obtained by echocardiography.Blood lipids and biomarkers of inflammation were measured.The differences of clinical data and EAT-related indicators were compared between the AF group and control group.Logistic multivariate regression analysis was used to determine the related factors of AF.Then the receiver operating characteristic(ROC)curve was used to determine the cutoff value of LA-EAT FDG SUVmax on the diagnosis of AF.Univariate and multivariate logistic regression analysis were used to analyze the relationship between the increase of LA-EAT FDG SUVmax and AF.Results The age was(66.9±10.2)years and there were 55 males(70.5%)in the AF group.The age was(66.9±8.0)years,and there were 52 males(66.7%)in the control group(both P>0.05).The LAD((44.2±5.8)mm vs.(35.4±4.4)mm),V-EAT((122.1±42.0)cm3 vs.(91.6±34.5)cm3),and LA-EAT FDG SUVmax((1.6±0.3)vs.(1.4±0.2))values were significantly higher,while LVEF((60.1±4.7)%vs.(63.9±2.9)%)was lower in the AF group than in the control group(P all<0.001).Multivariate logistic regression analysis showed that LAD(OR=1.340,95%CI 1.

关 键 词：心房颤动 ^(18)F-FDG PET/CT 心外膜脂肪 炎症 

分 类 号：R541.75[医药卫生—心血管疾病]