冠脉周围脂肪组织与疑诊冠状动脉狭窄所致心肌缺血的相关性研究  

Predictive Value of Pericoronary Adipose Tissue for Myocardial Ischemia in Patients with Suspected Coronary Artery Disease

作　　者：郭艳 李智勇 朱远 代岳 王淑芹 GUO Yan;LI Zhiyong;ZHU Yuan;DAI Yue;WANG Shuqin(Department of Imagine,the Affiliated Hospital of Xuzhou Medical University,Xuzhou 221004,China;Department of Nuclear Medicine,the Affiliated Hospital of Xuzhou Medical University,Xuzhou 221004,China)

机构地区：[1]徐州医科大学附属医院影像科,徐州221004 [2]徐州医科大学附属医院核医学科,徐州221004

出　　处：《中国医学计算机成像杂志》2024年第2期168-173,共6页Chinese Computed Medical Imaging

摘　　要：目的:探讨冠状动脉周围脂肪衰减指数(FAI)及心包外脂肪体积(EATV)与心肌缺血的相关性。方法:回顾性收集就诊于徐州医科大学附属医院的130例15天内行冠状动脉CT血管成像(CCTA)和心肌灌注显像(MPI)检查的患者,且CCTA提示至少一根血管存在狭窄。根据总积分差值(SDS)是否大于2分为心肌缺血组和非心肌缺血组,结合MPI结果及CCTA图像判断可能引起心肌缺血的主要责任血管,在CCTA图像上测量和计算FAI、EATV、Gensini积分及斑块长度,同时收集入组患者的基本资料[年龄、性别、体重指数(BMI)、高血脂、高血压],并进行两组间数据比较。采用单因素logistic回归分析心肌缺血和患者基本资料、EFAI、EATV、Gensini积分及斑块长度等指标的关系,并对存在显著性差异的指标行多因素回归分析。利用受试者工作特征(ROC)曲线比较不同指标预测心肌缺血的效能。结果:两组间患者性别、年龄、高血脂、高血压、FAI、EATV、Gensini积分及斑块长度等指标存在统计学差异。心肌缺血组的FAI、EATV、Gensini积分、斑块长度高于非心肌缺血组[-(69.01±11.59)HU vs-(83.38.49±8.11)HU,127.51(109.87,145.46)cm^(3)vs 108.34(99.92,116.9)cm^(3),16(10,25)分vs 9(5,13)分,18(12,30)mm vs 10.33(8.00,14.50)mm;均P<0.001]。FAI预测心肌缺血的价值高于EATV(AUC分别为0.892和0.837),FAI和EATV两指标联合对心肌缺血的预测效能进一步提高,且具有显著性差异(AUC=0.919,P<0.001)。结论:FAI、EATV对预测心肌缺血均具有一定的价值,FAI对心肌缺血的预测效能高于EATV,且两指标联合可进一步提高心肌缺血的预测效能。Purpose:To explore the association of coronary perivascular fat attenuation index(FAI)and epicardium adipose tissue volume(EATV)with myocardial ischemia.Methods:A total of 130 patients who underwent coronary computed tomography angiography(CCTA)and myocardial perfusion imaging(MPI)within 15 days were collected from the Affiliated Hospital of Xuzhou Medical University,and the CCTA results indicated vascular stenosis at least in one site.According to the standard of whether the summed difference score(SDS)>2,the patients were divided into myocardial ischemia group and non-myocardial ischemia group.Combined with MPI and CCTA images,the main responsible vessels of myocardial ischemia were determined.Meantime,FAI around the responsible vascular plaque,EATV,plaque length and Gensini score on CCTA images were measured and collected.Further,logistic regression analysis was performed to analyze the correlation among myocardial ischemia,FAI,EATV,Gensini score,plaque length and so on.Receiver operating characteristic(ROC)curve was used for evaluating the performance of each parameter.Results:Compared to non-myocardial ischemia group,myocardial ischemia group was with higher FAI,EATV,Gensini score and plaque length[-(69.01±11.59)HU vs-(83.38.49±8.11)HU,127.51(109.87,145.46)cm^(3) vs 108.34(99.92,116.9)cm^(3),16(10,25)points vs 9(5,13)points,18(12,30)mm vs 10.33(8.00,14.50)mm,P<0.001].FAI was with higher prediction efficacy than EATV(AUC=0.892,0.837).The combination of FAI and EATV further improved the predictive efficacy of myocardial ischemia(AUC=0.919,P<0.001).Conclusions:FAI and EATV can be used to predict myocardial ischemia,and FAI had a higher prediction efficacy than EATV.The combination of FAI and EATV can improve the prediction efficacy of myocardial ischemia.

关 键 词：心肌缺血 冠状动脉 脂肪衰减指数 心包外脂肪体积 

分 类 号：R541.4[医药卫生—心血管疾病]