代谢综合征合并冠状动脉粥样硬化性心脏病患者心包周围脂肪体积与冠状动脉病变严重程度的相关性

目的 测定代谢综合征（MS）合并冠状动脉粥样硬化性心脏病（CHD）患者心包内脂肪（EAT）、胸内脂肪（IAT）体积,探讨EAT、IAT体积、EAT/IAT比值与其冠状动脉粥样硬化程度的关系.方法 收集山西省人民医院2012年8月至2013年5月就诊的单纯MS患者97例,MS合并CHD患者118例.所有研究对象在64排CT扫描机上进行钙化积分及冠状动脉计算机断层扫描血管造影（CTA）.应用半自动Volume软件程序逐层手动描画心包内、外脂肪轮廓,并计算出相应EAT、心包外脂肪（PAT）、IAT体积,分析EAT、PAT、IAT相关危险因素及两组患者间EAT、IAT体积、EAT/IAT比值与钙化分级、钙化积分、Gensini积分的相关性.结果 （1）MS合并CHD组年龄大于单纯MS组（60.6±11.4）岁vs.（57.9±8.7）岁,P=0.001],有阳性心血管病家族史（29.7％vs.21.6％,P=0.03）、EAT（98.3±41.4）cm3 vs（82.2±39.7） cm3,P=0.001]、IAT（171.3±64.1）vs.（156.2±48.1） cm3,P=0.001]及糖化血红蛋白（HbA1c）显著增高（7.1±1.8）％vs.（6.6±2.3）％,P=0.02],而总胆固醇（TC）（4.9±1.2） mmol/Lv vs.（5.4±1.0）mmol/L,P=0.003]、低密度脂蛋白胆固醇（LDL-C）（3.0±1.1） mmol/L vs.（3.6±1.0）mmol/L,P=0.03]及高密度脂蛋白胆固醇（HDL-C）（1.0±0.4） mmol/L vs.（1.1 ±0.3） mmol/L,P=0.04]低于单纯MS组.（2）单纯MS者EAT、PAT、IAT体积均与性别、BMI、腰围、糖尿病、高脂血症相关（P＜0.05）; MS合并CHD者EAT、PAT、IAT体积均与BMI、腰围正相关（P＜0.05）.（3）MS合并CHD组EAT、IAT与钙化积分（r=0.45,P=0.017;r=0.5,P=0.013）、Gensini积分相关（r=0.476,P=0.015;r=0.563,P=0.017）,而EAT/IAT比值与钙化分级、Gensini积分无关,与钙化积分呈负相关（r=-0.321,P=0.028）.结论相同BMI及腰围下MS合并CHD心包周围脂肪EAT、IAT体积明显高于单纯MS;MS患者中,无论是否合并CHD,EAT、PAT、IAT体积均与BMI、腰围正相关.MS合并CHD者EAT、IAT体积与Gen

Correlation of pericardial adipose tissue with the severity of coronary artery atherosclerosis in coronary heart disease patients with metabolic syndrome

Objective To assess the volume of epicardial adipose tissue（EAT） and intrathoracic adipose tissue（IAT） and the correlation of EAT,IAT and the EAT/IAT ratio with the severity of coronary artery atherosclerosis in patients with metabolic syndrome（MS） and coronary heart disease（CHD）.Methods Ninty-seven MS subjects without coronary atherosclerosis and one hundred and eighteen MS subjects with CHD were enrolled in this study.The volumes of EAT,PAT and IAT were measured using axial data from base to apex traced manually with a dedicated semiautomatic software program-volume.Results （1）Compared with MS subjects without coronary atherosclerosis,MS subjects with CHD had significantly increased age（60.6± 1 1.4）years vs.（57.9 ± 8.7） years,P=0.001],positive family history of cardiovascular disease（29.7% vs.21.6%,P=0.03）,EAT（98.3±41.4） cm3 vs.（82.2±39.7） cm3,P=0.001],IAT （171.3±64.1） cm3 vs.（156.2±48.1） cm3,P=0.001] and HbA1c（7.1 ± 1.8）% vs.（6.6±2.3）%,P=0.02],but siginificantly reduced total cholesterolTC,（4.9 ± 1.2）mmol/L vs.（5.4 ± 1.0） mmol/L,P=0.003],low-density lipoprotein cholesterolLDL-C,（3.0±1.1） mmol/L vs.（3.6±1.0） mmol/L,P=0.03] and high-density lipoprotein cholesterolHDL-C,（1.0 ± 0.4） mmol/L vs.（1.1 ± 0.3） mmol/L,P=0.04].（2） In MS subjects without coronary atherosclerosis,the volumes of EAT,pericardial adipose tissue（PAT） and IAT were associated with gender,body mass index（BMI）,waist circumference（WC）,diabetes mellitus and hyperlipidemia（all P〈0.05）; however,in MS subjects with CHD,the volumes of EAT,PAT and IAT were associated with BMI and WC （both P〈0.05）.（3） The volumes of EAT and IAT were correlated with calcification grades（r values were 0.45 and 0.50,P values were 0.017 and 0.013,respectively） and Gensini score（r values were 0.476 and 0.563,P values were 0.015 and 0.017,respectively） instead of coronary artery calcifacation score（CACS）.Moreover,the EAT/IAT ratio was n