中老年冠心病患者超声心外膜脂肪垫厚度与冠状动脉易损斑块的相关性研究

摘要

Objective To investigate the association between epicardial adipose thickness(EAT)and coronary artery plaque vulnerability evaluated by intravascular ultrasound(IVUS)in patients with coronary heart disease.Methods A retrospective case-control study was conducted.A total of 261 patients who were diagnosed with coronary heart disease via coronary angiography from August 2014 to March 2017 were enrolled in this study.Patients were divided into an acute coronary syndrome(ACS)group(n=92)and a stable angina pectoris(SAP)group(n=169).EAT and coronary artery plaque vulnerability evaluated by IVUS were compared between the two groups.The correlation between EAT and coronary artery plaque vulnerability was analyzed.Results EAT was greater in the ACS group than in the SAP group(5.4 ± 1.1)mm vs.(2.9±0.7) mm,t =12.664,P＜0.01).The plaque burden,the rates of soft plaque detection and the rates of spotty calcification detection were higher in the ACS group than in the SAP group(67.8±8.0)％ vs.(57.4 ± 10.4) ％,35.9％ or 33/92 vs.18.9％ or 32/169,0.4 ％ or 28/92 vs.17.8％ or 30/169,all P ＜0.05),while there was no significant difference in luminal area between the two groups(P =0.772).The proportion of positive remodeling was higher in the ACS group than in the SAP group(35.9％ or 33/92 vs.8.3％ or 14/169,P＜0.01).Linear regression analysis showed that EAT was correlated with plaque burden(r =0.592,P ＜0.01),lumen area(r =-0.273,P ＜0.01) and reconstruction index(r =0.447,P ＜0.01).Conclusions Epicardial adipose thickness is correlated to coronary artery plaque vulnerability evaluated by IVUS.%目的 研究冠心病患者超声检查心外膜脂肪垫厚度(EAT)与血管内超声评价(IVUS)冠状动脉(冠脉)易损斑块的相关性.方法 回顾性病例对照研究,将我院行冠状动脉(冠脉)造影确诊为冠心病的患者261例,根据诊断分为急性冠脉综合征(ACS)组92例和稳定性心绞痛(SAP)组169例,比较两组患者超声检查EAT和IVUS评价冠脉易损斑块结果,观察两者的相关性.结果 ACS组患者的EAT大于SAP组,(5.4±1.1)mm比(2.9±0.7)mm(t=12.664,P＜0.01);其斑块负荷(67.8±8.0)％比(57.4±10.4)％,软斑检出率35.9％(33例)比18.9％(32例),点状钙化斑检出率30.4％(28例)比17.8％ (30例),均大于SAP组(均P＜0.05);两组的管腔面积差异无统计学意义(P=0.772);正性重构的比例ACS组较高,35.9％(33例)比8.3％(14例)(P＜0.01).EAT与斑块负荷(r=0.592,P＜0.01),管腔面积(r=-0.273,P＜0.01)及重构指数(r=0.447,P＜0.01)均相关.结论 EAT与冠脉内IUVS评价的斑块易损性相关.