心外膜脂肪组织及颈动脉内中膜厚度与冠心病的相关性研究

目的评价经高频超声测量的心外膜脂肪组织厚度(epicardial adipose tissue,EAT)和颈动脉内中膜厚度(intima-media thickness,IMT)对冠状动脉狭窄程度的预测价值。方法 92例接受冠状动脉血管内超声检查的患者,根据结果分为非冠心病(coronary artery disease,CAD)组25例和CAD组67例,CAD组依据病变程度分为轻、中、重三亚组;经超声测量EAT和IMT,对各组之间的EAT值和颈动脉IMT进行比较,将EAT和颈动脉IMT与CAD进行相关性分析。结果 CAD组与非CAD组比较,EAT和颈动脉IMT值明显升高[(6.54±1.21)mmvs.(4.98±1.33)mm,P<0.05;(1.02±0.20)mm vs.(0.83±0.18)mm,P<0.05];CAD三亚组之间随着病变程度的加重,EAT和颈动脉IMT值逐渐升高。直线相关分析显示EAT(r=0.624,P<0.001)及颈动脉IMT(r=0.392,P<0.001)与冠状动脉面积狭窄率呈直线正相关,Logistic回归分析表明EAT和颈动脉IMT均是CAD的独立危险因子,P值分别是0.028和0.032(P<0.05)。以EAT值≥5.16 mm诊断CAD,诊断敏感性83.6%,特异性68.0%,受试者工作曲线下面积为82.2%(P=0.001);以颈动脉IMT≥0.87 mm预测CAD的敏感性77.6%,特异性64.0%,受试者工作曲线下面积为76.6%(P=0.001)。结论经超声测量EAT和颈动脉IMT可作为评价冠状动脉病变程度简便、可靠和实用的评价指标,可作为CAD患者无创的协同诊断方法。

Relationships between epicardial adipose tissue thickness,intima-media thickness and coronary artery disease

Objectives To evaluate the predictive value of epicardial adipose tissue （EAT） thickness and intima-media thickness （IMT） measured by high-frequency ultrasound for coronary artery disease （CAD）. Methods Totally 92 patients were divided into 2 groups according to the results of intravascular ultrasonography （IVUS） ： CAD group （n=67） and control group （n=25）. Patients in CAD group were further divided into mild, moderate and severe subgroups. All the patients underwent echocardiographic measurements of EAT and IMT. The results were compared and correlation analysis was taken on CAD with EAT and IMT. Results EAT and IMT were significantly higher in CAD group compared with those in control group [ （6.54±1.21）mm vs. （4.98±1.33）mm, P〈0.05 ; （ 1.02±0.20）mm vs. （0.83±0.18）mm, P〈0.05]. Furthermore, EAT and IMT increased with the severity of CAD. EAT and IMT were positively correlated with the area stenosis rate of coronary artery （r=0.624, P〈0.001 ; r=0.392, P〈0.001）. Logistic regression analysis indicated that EAT and IMT were independent risk factors for CAD （P=0.028 and 0.032, P〈0.05）. With EATs〉5.16 mm as the cutoff value for diagnosing CAD, sensitivity and specificity were 83.6% and 68.0%, and operator characteristic curve area was 82.2% （P=0.001） ; with I MT ≥0.87 mm as the cutoff value, sensitivity and specificity were 77.6% and 64.0%, and operator characteristic curve area was 76.6% （P=0.001）. Conclusions EAT thickness and IMT evaluated by transthoracie echoeardiography are simple and practical methods for the assessment of the severity of CAD, and can be noninvasive ways in the collaborative diagnosis for CAD.