不同体质量指数人群冠状动脉病变与心外膜脂肪、胰岛素抵抗和C反应蛋白的关系

目的 研究肥胖及非肥胖人群C反应蛋白（CRP）、胰岛素抵抗（IR）及心外膜脂肪体积（EFV）对冠状动脉粥样硬化程度的影响.方法 入选同期行64排双源CT和经皮冠状动脉造影检查的103例患者,测量患者的身高、体质量、腰围（WC）,计算体质量指数（BMI）.根据BMI分为肥胖组45例和非肥胖组58例;通过64排双源CT测量EFV,收集空腹血液样本行血生化相关指标等检测.采用Gensini积分量化冠状动脉狭窄的严重程度.分析EFV和CRP及稳态胰岛素评估模型计算胰岛素抵抗指数（HOMA-IR）与Gensini积分之间的关系.结果 肥胖组CRP（11.0 ±5.8） mg/L]、WC（96.1±7.0） cm]、EFV（122.7±43.3） cm3]、BMI（27.9±2.9） kg/m2]高于非肥胖组CRP（6.5±3.4）mg/L]、WC（86.4±7.6）cm]、EFV（92.9±39.5）cm3]、BMI（22.4±1.9） kg/m2],两组比较差异有统计学意义（t值分别为2.24、6.74、3.64、11.74,P均＜0.05）.非肥胖组及肥胖组中CRP与EFV均呈正相关（r值分别为0.404、0.364,P均＜0.05）,而HOMA-IR仅在肥胖组中与BMI呈正相关（r=0.322,P＜0.05）.非肥胖人群中Gensini积分与EFV及CRP呈正相关（r值分别为0.358、0.315,P均＜0.05）,肥胖人群中Gensini积分与EFV、CRP及HOMA-IR呈正相关（r值分别为0.348、0.297、0.384,P均＜0.05）,经过BMI及WC的校正后,除肥胖组中与CRP的相关性消失外,余相关性均存在.最后以Gensini积分作为因变量进行多重线性回归分析,结果提示EFV和糖尿病为肥胖人群Gensini积分的独立危险因素.结论 在非肥胖及肥胖人群中,冠状动脉粥样硬化病变程度与EFV及CRP呈正相关,而在肥胖组中冠状动脉病变程度还受其他体脂分布（BMI、WC）及胰岛素抵抗水平的影响.EFV可作为影响冠状动脉粥样硬化病变程度的独立危险因素.

The correlations of coronary artery disease with epicardial adipose tissue,insulin resistance and C-reactive protein in different body mass index patients

Objective To evaluate the influence of C-reactive protein （CRP）,insulin resistance （IR） and epicardial fat volume （EFV） on the extent of coronary atherosclerosis in patients with different body mass index（BMl）.Methods One hundred and three patients with coronary artery disease were involved in current study who underwent 64-slice dual source CT and percutaneous coronary angiography.Measurements of height,weight,waist circumference （WC） were recorded,and BMI was calculated.All patients were divided into obesity group （n =45） and non-obesity group （n =58） based on BMI.EFV were calculated through 64-slice dual source CT.Blood samples were collected for biochemical examination.Gensini score were adopted to quantify the severity of coronary artery stenosis.The relationship between Gensini score and EFV,CRP and homeostasis model assessment-insulin resistance（HOMA-IR） index were statistical analyzed by SPSS16.0 software.Results The level of CRP,WC,EFV and BMI in obesity group were （11.0 ± 5.8） mg/L,（96.1 ± 7.0） cm,（122.7 ± 43.3） cm3,（27.9 ± 2.9） kg/m2 respectively,significantly higher than those in non-obesity group （（6.5 ± 3.4） mg/L,（86.4 ± 7.6） cm,（92.9 ± 39.5） cm3,（22.4 ± 1.9） kg/m2） and the differences were significant （t =2.24,6.74,3.64,11.74,and P 〈 0.05）.CRP were positively correlated with EFV （r =0.404,0.364,P 〈0.05） in both obesity and non-obesity group,While HOMA-IR were only associated with BMI in obese group（r =0.322,P 〈0.05）.Gensini score in non-obesity groups were positively related with EFV and CRP （r =0.358,0.315,P 〈 0.05）,while in obesity groups were positively related with EFV,CRP and HOMA-IR（r =0.348,0.297,0.384; P 〈 0.05）.The associations between Gensini score and CRP were not significant in obesity group after adjusting BMI and WC.Multiple linear regression analysis showed that EFV and diabetes mellitus were independent risk factors of patient Gensini score.Conclusion Coronary atherosclerosis is positively related with EFV and CRP in all patients.While,coronary atherosclerosis is influenced by BMI,WC and HOMA-IR in obese group.EFV is an independent risk factor of coronary atherosclerosis.