双源CT心周脂肪定量与冠状动脉病变特点及斑块类型的关系

摘要

目的 本研究通过64排双源CT测定心周脂肪组织(PAT)体积,分析PAT体积与冠状动脉病变支数、病变部位、病变狭窄程度以及斑块类型之间的关系,以期探讨PAT体积对冠状动脉粥样硬化病变程度的预测价值.方法 同期行64排双源CT和经皮冠状动脉造影检查的310例患者人选,进行腰围、体质指数(BMI)、空腹生化测定.使用64排双源CT测定PAT体积、钙化积分和斑块类型.通过经皮冠状动脉造影检查明确冠心病诊断、病变支数、病变部位,并采用Gensini积分量化冠状动脉狭窄的严重程度.结果 (1)冠心病患者的PAT体积明显大于非冠心病患者(P=0.004);急性冠脉综合征患者的PAT体积明显大于稳定性心绞痛患者(P=0.009).(2)双支和三支病变患者PAT体积与单支病变患者相比,PAT体积明显增加(P<0.001).(3)Gensini积分随着PAT体积增大而增加.(4)多元线性逐步回归分析显示PAT体积、BMI、空腹血糖是影响Censini积分的独立危险因素.(5)PAT体积与钙化积分具有明显正相关性(r=0.31.p<0.001).(6)混合型斑块的PAT体积最大,其病变节段积分明显高于其他类型(p<0.01).结论 PAT体积与冠心病的发生、冠心病分型、冠状动脉病变支数、钙化积分存在强的相关性,是影响Gensini积分的独立危险因素.%Objective Pericardial adipose tissue (PAT) a visceral fat depot may involve in the pathogenesis of coronary atherosclerosis. To gain evidence for that concept we sought to investigate the relation of pericardial fat volumes to severity, number and location of stenotic coronary vessels, coronary artery calcium (CAC) score, and plaque phenotype. Methods A total of 310 consecutive patients who underwent dual-source 64-slice CT and percutaneous coronary angiography were included for study. Each patient was taken the measurments of waist circumference, body mass index, blood biochemical parameters and PAT volume determined by dual source CT. Coronary angiograms were performed for the diagnosis of coronary artery disease (CAD). Gensini score was used for assessment of severity of coronary atherosclerosis. Results ( 1 ) PAT volumes in patients with CAD were higher than those in patients without CAD (P = 0. 004). PAT volumes in patients with acute coronary syndrome were significantly higher than those in patients with stable Angina ( P = 0. 009); ( 2 ) PAT volumes in patients with three- vessel lesion and two - vessel lesion were significantly higher than those in patients with one- vessel lesion (P ＜ 0. 001 );(3) An increase of PAT volume with an increasing Gensini score; (4) Multiple linear regression analysis showed that PAT volume, body mass index and fasting blood glucose were independent factors affecting Gensini score; ( 5 ) A significant correlation was revealed between PAT volume and C AC score ( r = 0. 31 ,P ＜0. 001 ); (6)Patients with mixture of all coronary plaque types showed a significant higher PAT volumes and segment score compared to patients with noncalcified and calcified coronary plaque (P ＜ 0. 01 ).Conclusions PAT volume was correlated with the severity and number of stenotic coronary vessels and CAC score and it was a independent factor affecting Gensini score.