心外膜脂肪组织体积与原发性高血压合并冠心病的相关性

doi:10.3969/j.issn.1004-583X.2021.08.005

摘要/Abstract

摘要：

目的探讨心外膜脂肪组织(EAT)体积与原发性高血压(EH)合并冠心病(CHD)的关系,并评价EAT体积对EH合并CHD的致病风险及预测价值。方法连续入选2014年12月-2017年6月于承德医学院附属医院心内科拟诊为稳定性CHD并行冠状动脉CT血管造影(CCTA)检查的EH患者408例,依据CCTA的结果将诊断CHD的患者设为研究组(n=319),非CHD患者设为对照组(n=89);比较两组临床基线资料及EAT体积的差异;受试者工作特征(ROC)曲线评估EAT体积对EH合并CHD的诊断价值,并确定最佳诊断界值;Logistic回归分析EH合并CHD的危险因素;Spearman相关性分析EAT体积与Gensini评分及冠状动脉钙化积分(CACS)的相关性。结果研究组EAT体积高于对照组(P<0.05);ROC曲线分析显示,EAT体积诊断EH合并CHD的曲线下面积(AUC)为0.698(P<0.05),当EAT体积取最佳诊断界值为172.5 cm³时,诊断EH合并CHD效能最高,敏感度和特异度分别为42.7%和94.3%;多因素Logistic回归分析显示,EAT体积≥172.5 cm³为EH合并CHD的独立危险因素(P<0.05),相对危险度为10.050(3.459~29.204);Spearman相关性分析显示,EAT体积与Gensini评分及CACS呈正相关(r=0.207、0.235,P<0.05)。结论 CCTA测量EAT体积可作为临床诊断EH合并CHD的无创辅助检查手段;EAT体积与EH患者的Gensini评分及CACS呈正相关,高EAT体积是EH合并CHD的独立危险因素。

关键词: 冠状动脉疾病, 心外膜标测, 高血压, 危险因素, 诊断

Abstract:

Objective To explore the relationship between epicardial adipose tissue(EAT) volume and essential hypertension(EH) with coronary heart disease(CHD) for its pathogenic risk and predictive value. Methods The study involved 408 patients with EH who underwent coronary computed tomographic angiography(CCTA) from December 2014 to June 2017 in our hospital. The patients were divided into study group (n=319) and control group (n=89) by CCTA diagnosis of CHD and non-CHD. The differences in terms of clinical baseline characteristics and EAT volume between two groups were compared. Receiver operating characteristic (ROC) curve were used to assess the diagnostic value of EAT volume for EH with CHD and to determine the optimal cut-off value. Logistic regression analysis to assess risk factors for combined CHD in EH. EAT volume with Gensini score and coronary artery calcification score (CACS) were evaluated with Spearman correlation analysis. Results The EAT volume was higher in CHD group than in non-CHD group (P<0.05). ROC curve analysis showed that the AUC of EAT volume in diagnosing EH combined CHD was 0.698(P<0.05). When the truncation value of EAT volume was 172.5 cm³, the diagnostic EH concurrent CHD was most effective, with the sensitivity and specificity of 42.7% and 94.3%. Multi-factor logistic regression analysis showed that EAT volume≥172.5 cm³ was independent risk factors for EH combined with CHD(P<0.05), the relative hazard level was 10.050(3.459-29.204).Spearman correlation analysis showed that EAT volume was positively correlated with Gensini scores and CACS (r=0.207, 0.235, P<0.05). Conclusion Measurement of EAT volume by CCTA may be a new clinical non-invasive diagnostic tool for EH with CHD. EAT volume was positively correlated with Gensini score and CACS in patients with EH. High EAT volume was an independent risk factor for EH with CHD.

Key words: coronary artery disease, epicardial mapping, hypertension, risk factors, diagnosis

中图分类号:

R541.4

王亚柱, 郭云飞, 司月乔, 刘超, 张英. 心外膜脂肪组织体积与原发性高血压合并冠心病的相关性[J]. 临床荟萃, 2021, 36(8): 699-703.

Wang Yazhu, Guo Yunfei, Si Yueqiao, Liu Chao, Zhang Ying. Correlation study of epicardial adipose tissue volume and essential hypertension with coronary heart disease[J]. Clinical Focus, 2021, 36(8): 699-703.

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链接本文: https://huicui.hebmu.edu.cn/CN/10.3969/j.issn.1004-583X.2021.08.005

https://huicui.hebmu.edu.cn/CN/Y2021/V36/I8/699

图/表 4

参考文献 18

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项目	研究组(n=319)	对照组(n=89)	χ²/Z值	P值
年龄≥60岁[例(%)]	169.00(52.98)	41.00(46.07)	1.330	0.249
男性[例(%)]	195.00(61.13)	29.00(32.58)	22.899	<0.001
2型糖尿病[例(%)]	98.00(30.72)	12.00(13.48)	10.500	0.001
吸烟[例(%)]	136.00(42.63)	22.00(24.72)	9.278	0.002
饮酒[例(%)]	75.00(23.51)	16.00(17.98)	1.186	0.276
CHD家族史[例(%)]	31.00(9.72)	9.00(10.11)	0.010	0.922
血脂异常[例(%)]	98.00(30.72)	33.00(37.08)	1.280	0.258
BMI≥24 kg/m²[例(%)]	239.00(74.92)	56.00(62.92)	5.004	0.025
心率(次/min)	72.00(66, 78)	72.00(66, 81)	-1.580	0.114
收缩压(mmHg)	140.00(130, 160)	144.00(130, 155)	-0.290	0.772
舒张压(mmHg)	85.00(80, 95)	90.00(80.00, 97.50)	-1.420	0.156
空腹血糖(mmol/L)	5.52(4.90, 6.82)	5.43(4.93, 6.50)	-0.972	0.331
白细胞(×10⁹/L)	6.72(5.54, 8.01)	7.00(5.53, 8.18)	-0.670	0.503
中性粒细胞百分比(%)	61.60(55.50, 67.90)	61.10(54.18, 67.25)	-0.562	0.574
淋巴细胞百分比(%)	28.75(22.37, 34.02)	30.25(25.25, 36.00)	-1.696	0.090
血小板计数(×10⁹/L)	222.00(185.50, 256.00)	229.50(195.50, 273.25)	-1.326	0.185
肌酐(μmol/L)	68.97(59.80, 80.445)	63.40(54.35, 74.13)	-2.906	0.004
尿素氮(mmol/L)	5.36(4.43, 6.37)	4.97(3.93, 5.84)	-2.368	0.018
尿酸(μmol/L)	316.20(263.45, 370.90)	312.55(256.78, 366.00)	-0.400	0.689
LDL-C≥3.40 mmol/L[例(%)]	49.00(15.36)	6.00(6.74)	3.544	0.046
HDL-C≤1.00 mmol/L[例(%)]	141.00(44.20)	47.00(52.81)	2.075	0.150
TG≥1.70 mmol/L[例(%)]	170.00(53.29)	42.00(47.19)	1.037	0.308
TC≥5.20 mmol/L[例(%)]	128.00(41.13)	10.00(11.24)	25.946	<0.001
EAT体积( cm³)	140.50(97.97, 231.25)	102(77.02, 131.50)	-5.680	<0.001
CACS(分)	197.00(26.00, 568.00)	0.00(0, 0)	-11.72	<0.001
Gensini 积分(分)	24.50(14.5, 52)	0.00(0, 0)	-14.296	<0.001

项目	研究组(n=319)	对照组(n=89)	χ²/Z值	P值
年龄≥60岁[例(%)]	169.00(52.98)	41.00(46.07)	1.330	0.249
男性[例(%)]	195.00(61.13)	29.00(32.58)	22.899	<0.001
2型糖尿病[例(%)]	98.00(30.72)	12.00(13.48)	10.500	0.001
吸烟[例(%)]	136.00(42.63)	22.00(24.72)	9.278	0.002
饮酒[例(%)]	75.00(23.51)	16.00(17.98)	1.186	0.276
CHD家族史[例(%)]	31.00(9.72)	9.00(10.11)	0.010	0.922
血脂异常[例(%)]	98.00(30.72)	33.00(37.08)	1.280	0.258
BMI≥24 kg/m²[例(%)]	239.00(74.92)	56.00(62.92)	5.004	0.025
心率(次/min)	72.00(66, 78)	72.00(66, 81)	-1.580	0.114
收缩压(mmHg)	140.00(130, 160)	144.00(130, 155)	-0.290	0.772
舒张压(mmHg)	85.00(80, 95)	90.00(80.00, 97.50)	-1.420	0.156
空腹血糖(mmol/L)	5.52(4.90, 6.82)	5.43(4.93, 6.50)	-0.972	0.331
白细胞(×10⁹/L)	6.72(5.54, 8.01)	7.00(5.53, 8.18)	-0.670	0.503
中性粒细胞百分比(%)	61.60(55.50, 67.90)	61.10(54.18, 67.25)	-0.562	0.574
淋巴细胞百分比(%)	28.75(22.37, 34.02)	30.25(25.25, 36.00)	-1.696	0.090
血小板计数(×10⁹/L)	222.00(185.50, 256.00)	229.50(195.50, 273.25)	-1.326	0.185
肌酐(μmol/L)	68.97(59.80, 80.445)	63.40(54.35, 74.13)	-2.906	0.004
尿素氮(mmol/L)	5.36(4.43, 6.37)	4.97(3.93, 5.84)	-2.368	0.018
尿酸(μmol/L)	316.20(263.45, 370.90)	312.55(256.78, 366.00)	-0.400	0.689
LDL-C≥3.40 mmol/L[例(%)]	49.00(15.36)	6.00(6.74)	3.544	0.046
HDL-C≤1.00 mmol/L[例(%)]	141.00(44.20)	47.00(52.81)	2.075	0.150
TG≥1.70 mmol/L[例(%)]	170.00(53.29)	42.00(47.19)	1.037	0.308
TC≥5.20 mmol/L[例(%)]	128.00(41.13)	10.00(11.24)	25.946	<0.001
EAT体积( cm³)	140.50(97.97, 231.25)	102(77.02, 131.50)	-5.680	<0.001
CACS(分)	197.00(26.00, 568.00)	0.00(0, 0)	-11.72	<0.001
Gensini 积分(分)	24.50(14.5, 52)	0.00(0, 0)	-14.296	<0.001

变量	回归系数	标准误	Wald χ²值	P值	OR值	95%CI
变量	回归系数	标准误	Wald χ²值	P值	OR值	下限	上限
男性	1.228	0.304	16.266	<0.001	3.414	1.880	6.201
吸烟	1.060	0.428	666.136	0.008	2.887	1.850	5.807
2型糖尿病	0.937	0.402	5.439	0.020	2.552	1.161	5.607
TC≥5.18 mmol/L	1.695	0.405	17.538	0.002	5.448	2.464	12.046
EAT体积≥172.5 cm³	2.308	0.544	17.978	<0.001	10.05	3.459	29.204
常数项	1.732	0.880	3.869	0.047	5.65

变量	回归系数	标准误	Wald χ²值	P值	OR值	95%CI
变量	回归系数	标准误	Wald χ²值	P值	OR值	下限	上限
男性	1.228	0.304	16.266	<0.001	3.414	1.880	6.201
吸烟	1.060	0.428	666.136	0.008	2.887	1.850	5.807
2型糖尿病	0.937	0.402	5.439	0.020	2.552	1.161	5.607
TC≥5.18 mmol/L	1.695	0.405	17.538	0.002	5.448	2.464	12.046
EAT体积≥172.5 cm³	2.308	0.544	17.978	<0.001	10.05	3.459	29.204
常数项	1.732	0.880	3.869	0.047	5.65

指标	EAT体积
指标	r值	P值
CACS(分)	0.235	<0.001
Gensini积分(分)	0.207	<0.001
年龄(岁)	0.018	0.714
BMI(kg/m²)	0.312	<0.001
空腹血糖(mmol/L)	0.097	0.064
心率(次/min)	0.017	0.728
收缩压(mmHg)	-0.068	0.176
舒张压(mmHg)	-0.064	0.188
白细胞(×10⁹/L)	0.073	0.161
中性粒细胞百分比(%)	0.027	0.596
淋巴细胞百分比(%)	-0.053	0.301
血小板计数(×10⁹/L)	-0.061	0.230
肌酐(μmol/L)	0.080	0.153
尿素氮(mmol/L)	0.062	0.239
尿酸(μmol/L)	0.069	0.173
LDL-C(mmol/L)	-0.003	0.961
HDL-C(mmol/L)	-0.161	0.002
TG(mmol/L)	0.082	0.107
TC(mmol/L)	-0.029	0.572