中华心血管病杂志
中華心血管病雜誌
중화심혈관병잡지
Chinese Journal of Cardiology
2015年
2期
134-140
,共7页
周亮亮%宫剑滨%李德闽%卢光明%陈栋%王璟
週亮亮%宮劍濱%李德閩%盧光明%陳棟%王璟
주량량%궁검빈%리덕민%로광명%진동%왕경
动脉粥样硬化%基质金属蛋白酶%瘦素%心外膜脂肪
動脈粥樣硬化%基質金屬蛋白酶%瘦素%心外膜脂肪
동맥죽양경화%기질금속단백매%수소%심외막지방
Atherosclerosis%Matrix metalloproteinase 9%Leptin%Epicardial adipose tissue
目的 评估心外膜脂肪体积(EATV)及心外膜脂肪局部分泌的炎症因子水平与冠状动脉粥样硬化斑块易损性的关系.方法 260例患者行64排双源CT评估冠状动脉狭窄程度并测定EATV,同期行外周血脂肪因子、胰岛素抵抗指数等检测.其中180例经DSA造影确诊冠心病,80例(包含40例瓣膜病术前检查病例)排除明显冠状动脉狭窄为对照组.180例冠心病患者经CTA图像测定斑块重构指数、脂质体积、钙化体积及纤维体积,并分析其与EATV的相关性.180例冠心病患者中40例接受冠状动脉旁路移植术(CABG),采集心外膜、胸腔内脂肪组织,分别用RT-PCR和Western blot法检测瘦素、基质金属蛋白酶9(MMP-9)的mRNA和蛋白表达水平.结果 (1)冠心病组EATV明显高于非冠心病组[(121.2 ±40.6)mm3比(74.7 ±18.1)mm3,P=0.01].(2)冠心病组内分析显示,血管正性重构患者(n=80)的EATV明显高于无重构及负重构患者(n=100)[(97.6±42.0) cm3比(75.5 ±25.4)cm3,P=0.01];脂质体积与EATV呈明显正相关(r=0.34,P=0.002),而斑块纤维体积与EATV呈负相关(r=-0.30,P=0.008).(3)logistic回归分析显示EATV是影响正性重构的独立危险因素(OR =2.01,95％ CI:1.30～2.32,P=0.01).(4)行CABG术的40例冠心病患者与40例非冠心病患者比较,心外膜脂肪瘦素、MMP9mRNA和蛋白的表达以及免疫活性均较高(P＜0.01),胸腔内脂肪瘦素、MMP9mRNA和蛋白的表达差异无统计学意义(P＞0.05).(5)冠心病患者心外膜脂肪瘦素、MMP9水平及EATV与斑块脂质体积、纤维体积均呈正相关(P均＜0.05).结论 EATV与冠心病斑块易损性指标相关,且独立于其他传统危险因素;冠心病患者心外膜炎症因子分泌量较非冠心病患者及胸廓内脂肪显著增加,心外膜炎症因子分泌量与EATV呈正相关,两者均是影响血管正性重构的因素.控制心外膜脂肪数量的增加及炎症状态将有助于降低斑块的易损性.
目的 評估心外膜脂肪體積(EATV)及心外膜脂肪跼部分泌的炎癥因子水平與冠狀動脈粥樣硬化斑塊易損性的關繫.方法 260例患者行64排雙源CT評估冠狀動脈狹窄程度併測定EATV,同期行外週血脂肪因子、胰島素牴抗指數等檢測.其中180例經DSA造影確診冠心病,80例(包含40例瓣膜病術前檢查病例)排除明顯冠狀動脈狹窄為對照組.180例冠心病患者經CTA圖像測定斑塊重構指數、脂質體積、鈣化體積及纖維體積,併分析其與EATV的相關性.180例冠心病患者中40例接受冠狀動脈徬路移植術(CABG),採集心外膜、胸腔內脂肪組織,分彆用RT-PCR和Western blot法檢測瘦素、基質金屬蛋白酶9(MMP-9)的mRNA和蛋白錶達水平.結果 (1)冠心病組EATV明顯高于非冠心病組[(121.2 ±40.6)mm3比(74.7 ±18.1)mm3,P=0.01].(2)冠心病組內分析顯示,血管正性重構患者(n=80)的EATV明顯高于無重構及負重構患者(n=100)[(97.6±42.0) cm3比(75.5 ±25.4)cm3,P=0.01];脂質體積與EATV呈明顯正相關(r=0.34,P=0.002),而斑塊纖維體積與EATV呈負相關(r=-0.30,P=0.008).(3)logistic迴歸分析顯示EATV是影響正性重構的獨立危險因素(OR =2.01,95％ CI:1.30～2.32,P=0.01).(4)行CABG術的40例冠心病患者與40例非冠心病患者比較,心外膜脂肪瘦素、MMP9mRNA和蛋白的錶達以及免疫活性均較高(P＜0.01),胸腔內脂肪瘦素、MMP9mRNA和蛋白的錶達差異無統計學意義(P＞0.05).(5)冠心病患者心外膜脂肪瘦素、MMP9水平及EATV與斑塊脂質體積、纖維體積均呈正相關(P均＜0.05).結論 EATV與冠心病斑塊易損性指標相關,且獨立于其他傳統危險因素;冠心病患者心外膜炎癥因子分泌量較非冠心病患者及胸廓內脂肪顯著增加,心外膜炎癥因子分泌量與EATV呈正相關,兩者均是影響血管正性重構的因素.控製心外膜脂肪數量的增加及炎癥狀態將有助于降低斑塊的易損性.
목적 평고심외막지방체적(EATV)급심외막지방국부분비적염증인자수평여관상동맥죽양경화반괴역손성적관계.방법 260례환자행64배쌍원CT평고관상동맥협착정도병측정EATV,동기행외주혈지방인자、이도소저항지수등검측.기중180례경DSA조영학진관심병,80례(포함40례판막병술전검사병례)배제명현관상동맥협착위대조조.180례관심병환자경CTA도상측정반괴중구지수、지질체적、개화체적급섬유체적,병분석기여EATV적상관성.180례관심병환자중40례접수관상동맥방로이식술(CABG),채집심외막、흉강내지방조직,분별용RT-PCR화Western blot법검측수소、기질금속단백매9(MMP-9)적mRNA화단백표체수평.결과 (1)관심병조EATV명현고우비관심병조[(121.2 ±40.6)mm3비(74.7 ±18.1)mm3,P=0.01].(2)관심병조내분석현시,혈관정성중구환자(n=80)적EATV명현고우무중구급부중구환자(n=100)[(97.6±42.0) cm3비(75.5 ±25.4)cm3,P=0.01];지질체적여EATV정명현정상관(r=0.34,P=0.002),이반괴섬유체적여EATV정부상관(r=-0.30,P=0.008).(3)logistic회귀분석현시EATV시영향정성중구적독립위험인소(OR =2.01,95％ CI:1.30～2.32,P=0.01).(4)행CABG술적40례관심병환자여40례비관심병환자비교,심외막지방수소、MMP9mRNA화단백적표체이급면역활성균교고(P＜0.01),흉강내지방수소、MMP9mRNA화단백적표체차이무통계학의의(P＞0.05).(5)관심병환자심외막지방수소、MMP9수평급EATV여반괴지질체적、섬유체적균정정상관(P균＜0.05).결론 EATV여관심병반괴역손성지표상관,차독립우기타전통위험인소;관심병환자심외막염증인자분비량교비관심병환자급흉곽내지방현저증가,심외막염증인자분비량여EATV정정상관,량자균시영향혈관정성중구적인소.공제심외막지방수량적증가급염증상태장유조우강저반괴적역손성.
Objective To investigate the relation of epicardial adipose tissue volume (EATV) determined by dual-source CT(DSCT) cardiac angiography and EAT-derived inflammatory factors to coronary heart disease (CHD) and vulnerable plaque.Methods A total of 260 patients underwent cardiac computed tomography to evaluate stenosis of coronary artery,and blood samples were obtained from each patient.CHD was confirmed in 180 patients by DSA and CHD was excluded in the remaining 80 patients (NCHD).Vascular remodeling index and plaque vulnerability parameters (fatty volume,fibrous volume and calcification volume and fiber volume) were measured in CHD patients and correlation with EATV was analyzed.Epicardial adipose tissue (EAT) and intrathoracic adipose tissue (TAT) were collected from 40 CHD patients undergoing CABG surgery,and,mRNA and protein expressions of leptin and MMP9 were detected by RT-PCR and Western blot analysis.Results (1) The EATV was significantly higher in the C HD group than in NCHD group ((121.2 ± 40.6) mm3 vs.(74.7 ± 18.1) mm3,P =0.01).(2) Subgroup analysis of the CHD patients demonstrated that EATV was significantly higher in patients with positive remodeling than in patients without positive remodeling ((97.6 ± 42.0) cm3 vs.(75.5 ± 25.4) cm3,P =0.01).Lipid plaque volume was positively correlated with EATV (r =0.34,P =0.002) ; however,fiber plaque volume was negatively correlated with EATV (r =-0.30,P =0.008).(3) Logistic regression analysis indicated that EATV was an independent risk factor for positive vascular remodeling(OR =2.01,95％ CI:1.30-2.32,P =0.01).(4) mRNA and protein expression of leptin and MMP9 in EAT was significantly upregulated in 40 CHD patients who received CABG surgery compared to 40 NCHD patients (P ＜ 0.01).However,there was no significant difference (P ＞ 0.05) in mRNA and protein expression of leptin and MMP9 from the SAT between CHD and NCHD patients.(5) In the CHD group,leptin and MMP9 levels in EAT and EATV were positively correlated with lipid plaque volume and fibrous plaque volume (P ＜ 0.05).Conclusions EATV is an independent risk factors of coronary heart disease and plaque vulnerability; EAT secretion of inflammatory cytokines from CHD patients is significant increased compared to NCHD patients,EAT secretion of inflammatory cytokines are positively correlated with EATV,both of which are determinants affecting vascular remodeling.Reducing EATV might help to attenuate inflammation and plaque vulnerability and reduce the risk of coronary heart disease.
