中华健康管理学杂志
中華健康管理學雜誌
중화건강관이학잡지
CHINESE JOURNAL OF HEALTH MANAGEMENT
2014年
3期
155-159
,共5页
原杰%张红霞%王丽佳%苏庆峰%唐笑先
原傑%張紅霞%王麗佳%囌慶峰%唐笑先
원걸%장홍하%왕려가%소경봉%당소선
代谢综合征X%冠状动脉疾病%动脉粥样硬化
代謝綜閤徵X%冠狀動脈疾病%動脈粥樣硬化
대사종합정X%관상동맥질병%동맥죽양경화
Metabolic syndrome X%Coronary artery disease%Atherosclerosis
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Gensini积分及钙化严重程度相关.
目的 測定代謝綜閤徵(MS)閤併冠狀動脈粥樣硬化性心髒病(CHD)患者心包內脂肪(EAT)、胸內脂肪(IAT)體積,探討EAT、IAT體積、EAT/IAT比值與其冠狀動脈粥樣硬化程度的關繫.方法 收集山西省人民醫院2012年8月至2013年5月就診的單純MS患者97例,MS閤併CHD患者118例.所有研究對象在64排CT掃描機上進行鈣化積分及冠狀動脈計算機斷層掃描血管造影(CTA).應用半自動Volume軟件程序逐層手動描畫心包內、外脂肪輪廓,併計算齣相應EAT、心包外脂肪(PAT)、IAT體積,分析EAT、PAT、IAT相關危險因素及兩組患者間EAT、IAT體積、EAT/IAT比值與鈣化分級、鈣化積分、Gensini積分的相關性.結果 (1)MS閤併CHD組年齡大于單純MS組[(60.6±11.4)歲vs.(57.9±8.7)歲,P=0.001],有暘性心血管病傢族史(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]及糖化血紅蛋白(HbA1c)顯著增高[(7.1±1.8)％vs.(6.6±2.3)％,P=0.02],而總膽固醇(TC)[(4.9±1.2) mmol/Lv vs.(5.4±1.0)mmol/L,P=0.003]、低密度脂蛋白膽固醇(LDL-C)[(3.0±1.1) mmol/L vs.(3.6±1.0)mmol/L,P=0.03]及高密度脂蛋白膽固醇(HDL-C)[(1.0±0.4) mmol/L vs.(1.1 ±0.3) mmol/L,P=0.04]低于單純MS組.(2)單純MS者EAT、PAT、IAT體積均與性彆、BMI、腰圍、糖尿病、高脂血癥相關(P＜0.05); MS閤併CHD者EAT、PAT、IAT體積均與BMI、腰圍正相關(P＜0.05).(3)MS閤併CHD組EAT、IAT與鈣化積分(r=0.45,P=0.017;r=0.5,P=0.013)、Gensini積分相關(r=0.476,P=0.015;r=0.563,P=0.017),而EAT/IAT比值與鈣化分級、Gensini積分無關,與鈣化積分呈負相關(r=-0.321,P=0.028).結論相同BMI及腰圍下MS閤併CHD心包週圍脂肪EAT、IAT體積明顯高于單純MS;MS患者中,無論是否閤併CHD,EAT、PAT、IAT體積均與BMI、腰圍正相關.MS閤併CHD者EAT、IAT體積與Gensini積分及鈣化嚴重程度相關.
목적 측정대사종합정(MS)합병관상동맥죽양경화성심장병(CHD)환자심포내지방(EAT)、흉내지방(IAT)체적,탐토EAT、IAT체적、EAT/IAT비치여기관상동맥죽양경화정도적관계.방법 수집산서성인민의원2012년8월지2013년5월취진적단순MS환자97례,MS합병CHD환자118례.소유연구대상재64배CT소묘궤상진행개화적분급관상동맥계산궤단층소묘혈관조영(CTA).응용반자동Volume연건정서축층수동묘화심포내、외지방륜곽,병계산출상응EAT、심포외지방(PAT)、IAT체적,분석EAT、PAT、IAT상관위험인소급량조환자간EAT、IAT체적、EAT/IAT비치여개화분급、개화적분、Gensini적분적상관성.결과 (1)MS합병CHD조년령대우단순MS조[(60.6±11.4)세vs.(57.9±8.7)세,P=0.001],유양성심혈관병가족사(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]급당화혈홍단백(HbA1c)현저증고[(7.1±1.8)％vs.(6.6±2.3)％,P=0.02],이총담고순(TC)[(4.9±1.2) mmol/Lv vs.(5.4±1.0)mmol/L,P=0.003]、저밀도지단백담고순(LDL-C)[(3.0±1.1) mmol/L vs.(3.6±1.0)mmol/L,P=0.03]급고밀도지단백담고순(HDL-C)[(1.0±0.4) mmol/L vs.(1.1 ±0.3) mmol/L,P=0.04]저우단순MS조.(2)단순MS자EAT、PAT、IAT체적균여성별、BMI、요위、당뇨병、고지혈증상관(P＜0.05); MS합병CHD자EAT、PAT、IAT체적균여BMI、요위정상관(P＜0.05).(3)MS합병CHD조EAT、IAT여개화적분(r=0.45,P=0.017;r=0.5,P=0.013)、Gensini적분상관(r=0.476,P=0.015;r=0.563,P=0.017),이EAT/IAT비치여개화분급、Gensini적분무관,여개화적분정부상관(r=-0.321,P=0.028).결론상동BMI급요위하MS합병CHD심포주위지방EAT、IAT체적명현고우단순MS;MS환자중,무론시부합병CHD,EAT、PAT、IAT체적균여BMI、요위정상관.MS합병CHD자EAT、IAT체적여Gensini적분급개화엄중정도상관.
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 cholesterol[TC,(4.9 ± 1.2)mmol/L vs.(5.4 ± 1.0) mmol/L,P=0.003],low-density lipoprotein cholesterol[LDL-C,(3.0±1.1) mmol/L vs.(3.6±1.0) mmol/L,P=0.03] and high-density lipoprotein cholesterol[HDL-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 negatively correlated with CACS(r=-0.321,P=0.028).Conclusions Compared with MS subjects without coronary atherosclerosis,MS subjects with CHD have significantly increased EAT and IAT volumes.In our subjects,the volumes of EAT,PAT and IAT were associated with BMI and WC.Only in MS subjects with CHD,the volumes of EAT and IAT were correlated with caleification and Gensini score.
