CAJ | 학술논문

目的在代谢综合征(MS)患者中探讨心外膜脂肪体积(EFV)与运动试验后心率恢复异常(HRR)的相关性.方法选取2011年7月至9月在太原市东方社区、亲凤苑社区进行代谢综合征(MS)流行病学调查获得的人群以及在我院健康体检并行胸部CT平扫检查的人群(486人)为研究对象,共入选109例MS患者和41名健康对照者,所有受试者均进行问卷调查、体格检查并抽取空腹血进行生化检测.行冠状动脉CT造影(CCTA)除外血管阻塞面积≥50％的有意义狭窄,同时计算EFV,并进行运动平板试验,计算运动试验后运动时最高心率与恢复期的第1分钟内心率的差值(HRR-1).结果 MS组EFV较健康对照组显著增高[(182±50)比(159±62) cm3,t=6.91,P＜0.05],而HRR-1则显著降低[(21±8)比(26 ±9)次/min,t=-5.74,P＜0.05]；在MS患者中,HRR-1异常者EFV较HRR-1正常者显著增高[(197±56)比(178±62)cm3,t=7.90,P＜0.05].Logistic多元回归分析示EFV是HRR-1异常的独立危险因素(OR=2.46,P＜0.05).应用受试者工作曲线(ROC)分析发现当EFV≥163.4 cm3时,预测HRR-1异常的敏感性为86.1％,特异性为57.3％(ROC曲线下面积为0.74).结论 EFV是MS患者HRR异常的独立危险因素.
목적 재대사종합정(MS)환자중탐토심외막지방체적(EFV)여운동시험후심솔회복이상(HRR)적상관성.방법 선취2011년7월지9월재태원시동방사구、친봉원사구진행대사종합정(MS)류행병학조사획득적인군이급재아원건강체검병행흉부CT평소검사적인군(486인)위연구대상,공입선109례MS환자화41명건강대조자,소유수시자균진행문권조사、체격검사병추취공복혈진행생화검측.행관상동맥CT조영(CCTA)제외혈관조새면적≥50％적유의의협착,동시계산EFV,병진행운동평판시험,계산운동시험후운동시최고심솔여회복기적제1분종내심솔적차치(HRR-1).결과 MS조EFV교건강대조조현저증고[(182±50)비(159±62) cm3,t=6.91,P＜0.05],이HRR-1칙현저강저[(21±8)비(26 ±9)차/min,t=-5.74,P＜0.05]；재MS환자중,HRR-1이상자EFV교HRR-1정상자현저증고[(197±56)비(178±62)cm3,t=7.90,P＜0.05].Logistic다원회귀분석시EFV시HRR-1이상적독립위험인소(OR=2.46,P＜0.05).응용수시자공작곡선(ROC)분석발현당EFV≥163.4 cm3시,예측HRR-1이상적민감성위86.1％,특이성위57.3％(ROC곡선하면적위0.74).결론 EFV시MS환자HRR이상적독립위험인소.
Objective To evaluate the association between epicardial fat volume (EFV) and blunted heart rate recovery(HRR) in patients with metabolic syndrome(MS).Methods Screening subjects in epidemiologic study of metabolic syndrome in Oriental and Qinfeng Community in Taiyuan and health physical examination in Shanxi Province People's Hospital,which was conducted among 486 patients from July to September in 2011,one hundred and nine patients with MS and forty one healthy controls were included in the study.All subjects received a questionnaire survey and physical examination.Laboratory results included fasting blood glucose,glycosylated hemoglobin,triglyceride,cholesterol,low-density lipoprotein cholesterol,high-density lipoprotein cholesterol,uria acid and fasting insulin were also collected.Coronary computed tomography angiography(CCTA) was performed to exclude obstructive disease(≥50％ luminal narrowing).Then EFV and HRR at 1 min after exercise termination(HRR-1)were measured and compared between two groups.Results EFV((159 ±62) vs (182 ±50) cm3,t =6.91,P ＜0.05) was increased and HRR-1 ((21 ± 8) vs (26 ± 9) time/min,t =-5.74,P ＜ 0.05) was significantly reduced in patients with MS compared to those in control group.Among the MS patients,subjects with blunted HRR had increased EFV compared to patients without blunted HRR((197 ± 56) vs (178 ± 62) cm3,t =7.90,P ＜0.05).In multivariate analysis,EFV was the only independent predictor of blunted HRR in patients with MS(OR =2.46,P ＜ 0.05).Furthermore EFV of equel to or bigger than 163.4 cm3 was associated with the blunted HRR with 86.1％ sensitivity and 57.3％ specificity (ROC area under curve:0.74).Conclusion EFV is an independent predictor of blunted HRR in patients with MS.