摘要
目的:探讨心表面脂肪(epicardial adipose tissue,EAT)体积与稳定型心绞痛(stable angina pectoris,SAP)患病的相关性。方法:承德医学院附属医院2015-06-2017-06疑似冠心病住院患者688例,连续入选初步诊断为SAP并符合纳入标准的患者365例,按照冠状动脉(冠脉)狭窄程度分为SAP组(205例)及非冠心病组(160例)。通过对冠脉CT血管造影(coronary computed tomographic angiography,CCTA)图像重建后,测量EAT体积。依据BMI将研究对象再分为BMI≥24亚组与BMI<24亚组,并分别拟合二元Logistic多因素回归模型,定量分析EAT体积与SAP患病的相关性。结果:SAP组EAT体积高于非冠心病组[132.00(91.04,235.00) cm^3∶100.00(73.87,129.50) cm^3,P<0.001],差异有统计学意义(P<0.001)。EAT体积ROC曲线下面积(AUC)为0.673(95%CI:0.619~0.728),最佳诊断界值为175.00 cm^3,敏感度、特异度、阳性预测值、阴性预测值分别为34.91%、93.23%、90.00%、56.09%;在BMI<24亚组中,EAT体积AUC为0.530(95%CI:0.415~0.644),EAT体积的最佳诊断界值为176.87 cm^3,无统计学意义(P=0.607);而BMI≥24亚组中,EAT体积AUC为0.720(95%CI:0.655~0.785),有统计学意义(P<0.001),最佳诊断界值为165.00 cm^3,敏感度、特异度、阳性预测值、阴性预测值分别为46.21%、92.11%、91.78%、47.30%。Logistic回归模型分析显示,EAT体积增生为SAP的独立危险因素(OR:15.250;95%CI:5.445~42.713);BMI<24亚组中,EAT体积增生为SAP的独立危险因素(OR:9.238,95%CI:1.535,55.614);BMI≥24亚组中,EAT体积增生亦为SAP的独立危险因素(OR:18.844,95%CI:5.701,62.292)。结论:EAT体积增大是SAP患病的独立危险因素,CCTA测量EAT体积可作为临床诊断SAP的无创辅助检查手段,尤其对于超重与肥胖人群具有更大的诊断价值。
Objective:To explore the correlation between the volume of epicaldial adipose tissue(EAT)and stable angina pectoris(SAP).Method:A total of 365 patients with suspected SAP from June 2015 to June 2017 in the Affiliated Hospital of Chengde Medical College were consecutively enrolled.All patients were divided into SAP group(n=205)and non-coronary heart disease group(n=160)according to the degree of coronary artery stenosis assessed by coronary computed tomographic angiography(CCTA).EAT volume was calculated via a 3 D image software in the CCTA workstation.All subjects were divided into BMI≥24 and BMI<24 subgroup.Multivariate logistic regression models were used to quantitatively analyze the correlation between EAT volume and SAP.Result:EAT volume was significantly higher in SAP group than that in non-coronary heart disease group[132.00(91.04,235.00)cm^3 vs 100.00(73.87,129.50)cm^3,P<0.001].The area under ROC curve(AUC)of EAT volume was 0.673(95%CI:0.619-0.728),the best diagnostic threshold was 175.00 cm^3,and the sensitivity,specificity,positive predictive value and negative predictive value were 34.91%,93.23%,90.00%and 56.09%,respectively.In the BMI<24 subgroup,the AUC of EAT volume was 0.530(95%CI:0.415-0.644),the best diagnostic threshold was 176.87 cm^3,but there was no statistical significance(P=0.607).In the BMI≥24 subgroup,the AUC of EAT volume was 0.720(95%CI:0.655-0.785,P<0.001),the best diagnostic threshold was165.00 cm^3,and the sensitivity,specificity,positive predictive value and negative predictive value were 46.21%,92.11%,91.78%and 47.30%,respectively.Logistic regression analysis showed that EAT volume was an independent risk factor for SAP(OR:15.250;95%CI:5.445-42.713).In the BMI<24 subgroup,EAT volume was an independent risk factor for SAP(OR:9.238,95%CI:1.535-55.614);In the BMI≥24 subgroup,EAT volume was also an independent risk factor for SAP(OR:18.844,95%CI:5.701-62.292).Conclusion:The EAT volume enlargement is an independent risk factor for the development of SAP.Measurement of EAT volume b
作者
韩超
崔志新
丁振江
刘静怡
高秀鑫
司月乔
刘佟
孙王乐贤
HAN Chao;CUI Zhixin;DING Zhenjiang;LIU Jingyi;GAO Xiuxin;SI Yueqiao;LIU Tong;SUN Wanglexian(Division of Cardiovascular Medicine,The Affiliated Hospital of Chengde Medical College,Chengde Cardiovascular Institute,Chengde,Hebei,067000,China;Division of Radiology,The Affiliated Hospital of Chengde Medical College)
出处
《临床心血管病杂志》
CAS
北大核心
2019年第9期785-789,共5页
Journal of Clinical Cardiology
基金
河北省科学技术厅指令性计划项目(No:17277769D)
关键词
心表面脂肪
稳定型心绞痛
冠状动脉CT血管造影
诊断
epicardial adipose tissue
stable angina pectoris
coronary computed tomographic angiography
diagnosis
