心外膜脂肪组织与冠心病经皮冠状动脉介入治疗患者临床预后的关系
发布时间：2019-02-27 08:43
【摘要】：研究目的:观察接受冠状动脉介入治疗(percutaneous coronary intervention,PCI)的冠心病患者1年内其主要不良心血管事件(major adverse cardiovascular events,MACE),探讨心外膜脂肪组织(epicardial adipose tissue,EAT)与冠心病患者PCI术后预后的关系,评估心外膜脂肪组织在冠心病患者发病与临床预后中的价值,为改善PCI术后患者的临床预后提供新的靶点。研究方法:本研究前瞻性入选2013年12月-2014年11月到泰达国际心血管病医院内一科接受冠状动脉介入治疗的冠心病患者237例,于PCI术前通过多排平扫CT(multi-sclice CT,MSCT)测量心外膜脂肪组织容积(epicardial adipose tissue volume,EATV),根据入选者EATV测量结果将其分为三组,分别为A组(EATV"f75cm3),B组(75cm3EATV150cm3),C组(EATV"g150cm3)。分别化验三组患者血清的血脂、血糖、白细胞介素(interleukin,IL)-6、肿瘤坏死因子(tumor necrosis factor,TNF)-α、超敏C反应蛋白(hypersensitive c-reactive protein,Hs-CRP)以及脂联素水平。待各项检查完善后,如果没有冠脉造影(Coronar Angiography,CAG)禁忌症,安排择期行CAG及PCI术。分析评估EATV水平与炎性因子及冠状动脉粥样硬化性心脏病(coronary heart disease,CHD)常规危险因素间的关系,同时随访观察所有入选病人1年内的MACE发生的数量,探讨EATV水平与PCI术后患者MACE发生的相关性。研究结果:将A、B、C三组的一般资料进行比较可见,三组在年龄、性别、合并高血压、合并糖尿病、吸烟情况、空腹血糖、TC、TG、LDL及HDL水平方面差异无统计学意义(p0.05),而从BMI、hs-CRP、IL-6、TNF-α方面比较:B组水平高于A组,C组水平分别高于A、B两组,三组差异具有统计学意义(p0.01或p0.05)。而脂联素水平比较A组高于B、C两组,B组高于C组,三组差异具有显著统计学意义(p0.01)。然后从上述五个有统计学意义的指标出发,与患者EATV水平做Spearman二变量相关分析,结果显示:EATV与hs-CRP,IL-6,TNF-α呈显著正相关(r=0.675~0.700,p0.01),与脂联素呈显著负相关(r=-0.629,p0.01),而与BMI有较弱的正相关性(r=0.410,p0.01)。分别记录三组患者MACE发生的数量,并进行比较,数量从高到低依次为C、B、A组,三组具有显著的统计学意义(p0.01),然后将EATV水平与MACE的发生做ROC曲线,ROC曲线分析:EATV水平预测MACE事件发生的曲线下面积为0.779(95%CI:0.669~0.889,p0.01),界值为116.11cm3,敏感性和特异性分别为86.4%,60%,可见EATV水平对MACE的发生具有良好的预测价值.最后,将MACE事件的发生与冠心病常见危险因子行logistic回归分析得知:EATV116.11cm3(OR=4.584,p0.01),多支病变(OR=3.416,p0.05)及不完全血运重建(OR=1.103,p0.05)是PCI术后MACE事件发生的独立危险因素。研究结论:EAT作为一个内脏脂肪组织的代表可分泌大量的CRP,白细胞介素-6,TNF-α等炎性因子,这些因子共同抑制脂联素的分泌。EATV水平与PCI术后患者MACE事件的发生密切相关,且EATV116.11cm3,多支病变及不完全血运重建是PCI术后患者1年内发生MACE的独立危险因素,可以用于评估及预测冠心病患者PCI术后的预后情况,其将不仅在学术研究中受到青睐,也为将来心血管疾病的治疗提供新的靶点。
[Abstract]:Objective: To study the relationship between epicardial adipose tissue (EAT) and prognosis after PCI in patients with coronary heart disease (CHD) undergoing coronary intervention (PCI). To evaluate the value of epicardial adipose tissue in the pathogenesis and prognosis of coronary heart disease, and to provide a new target for improving the clinical prognosis of patients with PCI. Methods: In this study,237 patients with coronary heart disease treated with coronary intervention were prospectively selected from December 2013 to November 2014, and the epicardial adipose tissue volume (EATV) was measured by multi-scan CT (MSCT) before PCI. The results of the EATV measurements were divided into three groups, respectively (EATV "f75cm3, Group B (75cm3EATV150cm3), Group C (EATV" g150cm3). Blood lipids, blood glucose, interleukin (IL)-6, tumor necrosis factor (TNF)-1, hypersensitive C-reactive protein (Hs-CRP) and adiponectin levels in the serum of three groups were tested. After the examination and improvement, if there was no contraindication of coronary angiography (CAG), the patients were scheduled for CAG and PCI. The relationship between the level of EATV and the routine risk factors of the inflammatory and coronary heart disease (CHD) was assessed, and the number of MACE occurring within 1 year of all the enrolled patients was observed, and the correlation between the level of EATV and the MACE in patients after PCI was discussed. Results: The general data of group A, B and C were compared, and the difference of three groups in age, sex, combined hypertension, diabetes, smoking, fasting blood glucose, TC, TG, LDL and HDL was not significant (p0.05), and from BMI, hs-CRP, IL-6, Compared with group A and group B, group B was higher in group B than in group A and group B, and the difference of group B was statistically significant (p0.01 or p0.05). The level of adiponectin in group A was higher than that in group B and C, and group B was higher than that in group C. The results showed that EATV was positively correlated with hs-CRP, IL-6 and TNF-1 (r = 0.675-0.700, p0.01) and negatively correlated with adiponectin (r =-0.629, p0.01). However, there was a positive correlation with BMI (r = 0.410, p0.01). The number of MACE in the three groups was recorded, and the number of MACE in the three groups was compared. The number of MACE in the three groups was from high to low in order of C, B and A, and the three groups had significant statistical significance (p0.01), and then the ROC curve and the ROC curve of the EATV level and the MACE were analyzed. The EATV level predicted that the area of the MACE event was 0.779 (95% CI: 0.669-0.889, p0.01), the boundary value was 116.11 cm3, the sensitivity and specificity were 86.4% and 60%, respectively, and the visible EATV level had good predictive value for the occurrence of MACE. Finally, the occurrence of MACE events and the common risk factors of coronary heart disease were obtained by logistic regression analysis: EATV116.11 cm3 (OR = 4.584, p0.01), multiple lesions (OR = 3.416, p0.05) and incomplete revascularization (OR = 1.103, p0.05) were independent risk factors for the occurrence of MACE events after PCI. Conclusion: EAT, as a representative of visceral adipose tissue, can secrete a large amount of inflammatory factors such as CRP, interleukin-6, and TNF-1, which co-inhibit the secretion of adiponectin. The level of EATV is closely related to the occurrence of MACE in patients after PCI, and EATV116.11 cm3, multivessel disease and incomplete revascularization are independent risk factors of MACE within 1 year after PCI, and can be used to evaluate and predict the prognosis of patients with coronary heart disease after PCI. It will not only be favored in academic research, but also provide a new target for future treatment of cardiovascular disease.
【学位授予单位】：天津医科大学
【学位级别】：硕士
【学位授予年份】：2016
【分类号】：R541.4
[Abstract]:Objective: To study the relationship between epicardial adipose tissue (EAT) and prognosis after PCI in patients with coronary heart disease (CHD) undergoing coronary intervention (PCI). To evaluate the value of epicardial adipose tissue in the pathogenesis and prognosis of coronary heart disease, and to provide a new target for improving the clinical prognosis of patients with PCI. Methods: In this study,237 patients with coronary heart disease treated with coronary intervention were prospectively selected from December 2013 to November 2014, and the epicardial adipose tissue volume (EATV) was measured by multi-scan CT (MSCT) before PCI. The results of the EATV measurements were divided into three groups, respectively (EATV "f75cm3, Group B (75cm3EATV150cm3), Group C (EATV" g150cm3). Blood lipids, blood glucose, interleukin (IL)-6, tumor necrosis factor (TNF)-1, hypersensitive C-reactive protein (Hs-CRP) and adiponectin levels in the serum of three groups were tested. After the examination and improvement, if there was no contraindication of coronary angiography (CAG), the patients were scheduled for CAG and PCI. The relationship between the level of EATV and the routine risk factors of the inflammatory and coronary heart disease (CHD) was assessed, and the number of MACE occurring within 1 year of all the enrolled patients was observed, and the correlation between the level of EATV and the MACE in patients after PCI was discussed. Results: The general data of group A, B and C were compared, and the difference of three groups in age, sex, combined hypertension, diabetes, smoking, fasting blood glucose, TC, TG, LDL and HDL was not significant (p0.05), and from BMI, hs-CRP, IL-6, Compared with group A and group B, group B was higher in group B than in group A and group B, and the difference of group B was statistically significant (p0.01 or p0.05). The level of adiponectin in group A was higher than that in group B and C, and group B was higher than that in group C. The results showed that EATV was positively correlated with hs-CRP, IL-6 and TNF-1 (r = 0.675-0.700, p0.01) and negatively correlated with adiponectin (r =-0.629, p0.01). However, there was a positive correlation with BMI (r = 0.410, p0.01). The number of MACE in the three groups was recorded, and the number of MACE in the three groups was compared. The number of MACE in the three groups was from high to low in order of C, B and A, and the three groups had significant statistical significance (p0.01), and then the ROC curve and the ROC curve of the EATV level and the MACE were analyzed. The EATV level predicted that the area of the MACE event was 0.779 (95% CI: 0.669-0.889, p0.01), the boundary value was 116.11 cm3, the sensitivity and specificity were 86.4% and 60%, respectively, and the visible EATV level had good predictive value for the occurrence of MACE. Finally, the occurrence of MACE events and the common risk factors of coronary heart disease were obtained by logistic regression analysis: EATV116.11 cm3 (OR = 4.584, p0.01), multiple lesions (OR = 3.416, p0.05) and incomplete revascularization (OR = 1.103, p0.05) were independent risk factors for the occurrence of MACE events after PCI. Conclusion: EAT, as a representative of visceral adipose tissue, can secrete a large amount of inflammatory factors such as CRP, interleukin-6, and TNF-1, which co-inhibit the secretion of adiponectin. The level of EATV is closely related to the occurrence of MACE in patients after PCI, and EATV116.11 cm3, multivessel disease and incomplete revascularization are independent risk factors of MACE within 1 year after PCI, and can be used to evaluate and predict the prognosis of patients with coronary heart disease after PCI. It will not only be favored in academic research, but also provide a new target for future treatment of cardiovascular disease.
【学位授予单位】：天津医科大学
【学位级别】：硕士
【学位授予年份】：2016
【分类号】：R541.4
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