心外膜脂肪垫厚度与冠脉支架内再狭窄的相关性分析
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摘要
目的研究观察心外膜脂肪垫厚度(EAT)与冠脉支架内再狭窄(ISR)的关系。方法回顾性分析2013年10月至2015年10月期间本院收治的支架植入术后1年复查冠脉造影的患者作为研究对象,按有无支架内再狭窄分为再狭窄组及对照组,所有患者完成EAT的超声检测及生化检测,对比观察两组患者EAT及生化指标的血浆水平。结果再狭窄组的EAT大于对照组[(7. 78±1. 32) mm vs (4. 19±0. 57) mm,t=22. 998,P <0. 001],同时发现再狭窄组的早发心血管病家族史及冠脉病变严重程度均高于对照组,生化检验提示再狭窄组血浆甘油三酯、糖化血红蛋白、同型半胱氨酸、超敏C反应蛋白及尿酸水平均高于对照组(P <0. 05)。多因素logistic回归分析提示EAT与ISR的发生存在一定相关性[Exp(B)=0. 001,P=0. 004],一元线性回归分析提示EAT与支架内再狭窄严重程度高度相关(r=0. 891,P <0. 001)。结论心外膜脂肪垫厚度与冠脉支架内再狭窄及其严重程度具有相关性,可能成为冠脉支架内再狭窄的高危因素之一。
Objective To investigate the association between epicedial adipose thickness( EAT and coronary artery in-stent restenosis( ISR). Methods 617 patients underwent review of coronary angiography in one year of drug-eluting stent implantation in our hospital from October 2013 to October 2015 were enrolled in the study. According to the angiography resluts,patients were divided into ISR group and control group. All cases recieved ultrasonic analysis of epicardial adipose thickness and biochemical test. The correlation of EAT,biochemical concentrations and ISR were determined. Results The EAT in ISR group was significantly higher than that in the control group [( 7. 78 ± 1. 32) mm vs( 4. 19 ± 0. 57) mm,t = 22. 998,P < 0. 001]. It was also found that the family history of premature coronary artery disease and the severity of coronary artery lessions based on Syntax scores in the IRS group were higher than those in normal control group. Biochemical tests showed that plasma levels of triglycerides and glycosylated hemoglobin were higher,including plasma homocysteine and hypersensitive C-reactive protein( P < 0. 05). Multivariates logistic regression analysis suggested that the EAT was associated with ISR [Exp( B) = 0. 001,P = 0. 004]. Moreover,one-way linear regression showed that EAT was correlated with the severity of IRS( r = 0. 891,P <0. 001). Conclusions Epicardial adipose thickness was correlated with the occurrence and severity of coronary artery in-stent restenosis.
Objective To investigate the association between epicedial adipose thickness( EAT and coronary artery in-stent restenosis( ISR). Methods 617 patients underwent review of coronary angiography in one year of drug-eluting stent implantation in our hospital from October 2013 to October 2015 were enrolled in the study. According to the angiography resluts,patients were divided into ISR group and control group. All cases recieved ultrasonic analysis of epicardial adipose thickness and biochemical test. The correlation of EAT,biochemical concentrations and ISR were determined. Results The EAT in ISR group was significantly higher than that in the control group [( 7. 78 ± 1. 32) mm vs( 4. 19 ± 0. 57) mm,t = 22. 998,P < 0. 001]. It was also found that the family history of premature coronary artery disease and the severity of coronary artery lessions based on Syntax scores in the IRS group were higher than those in normal control group. Biochemical tests showed that plasma levels of triglycerides and glycosylated hemoglobin were higher,including plasma homocysteine and hypersensitive C-reactive protein( P < 0. 05). Multivariates logistic regression analysis suggested that the EAT was associated with ISR [Exp( B) = 0. 001,P = 0. 004]. Moreover,one-way linear regression showed that EAT was correlated with the severity of IRS( r = 0. 891,P <0. 001). Conclusions Epicardial adipose thickness was correlated with the occurrence and severity of coronary artery in-stent restenosis.
引文
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[2]刘志江,石蓓,邓婵翠,等.药物洗脱支架置入术后支架内再狭窄伴新生动脉粥样硬化形成的光学相干断层成像分析[J].中华心血管病杂志,2018,46(1):44-49. DOI:10. 3760/cma. j.issn. 0253-3758. 2018. 01. 008.
[3]Liu Q,Huang X,Oh JH,et al. Epicardium-to-fat transition in injured heart[J]. Cell Res,2014,24(11):1367-1369. DOI:10.1038/cr. 2014. 125.
[4]夏洪波,邓又斌,杨好意,等.高频超声测量心外膜脂肪组织厚度与冠心病危险因素的相关性分析[J].中华超声影像学杂志,2011,20(3):197-200. DOI:10. 3760/cma. j. issn. 1004-4477. 2011. 03. 005.
[5]PrídavkováD,KantárováD,LikováR,et al. The role of epicardial fat and obesity parameters in the prediction of coronary heart disease[J]. Vnitr Lek,2016,62(4):256-262.
[6]?etin M,Kocaman SA,Durakoglugil ME,et al. Effect of epicardial adipose tissue on diastolic functions and left atrial dimension in untreated hypertensive patients with normal systolic function[J]. J Cardiol,2013,61(5):359-364. DOI:10. 1016/j. jjcc.2012. 12. 015.
[7]Drapkina OM,Zyatenkova EV. Evaluation of cardiovascular remodeling and epicardial fat thickness in patients with chronic heart failure and metabolic syndrome[J]. Ter Arkh,2016,88(2):64-70.
[8]Gul I,Zungur M,Aykan AC,et al. The Relationship between GRACE Score and Epicardial Fat Thickness in non-STEMI Patients[J]. Arq Bras Cardiol,2016,106(3):194-200. DOI:10.5935/abc. 20160024.
[9]Bo X,Ma L,Fan J,et al. Epicardial fat volume is correlated with coronary lesion and its severity[J]. Int J Clin Exp Med,2015,8(3):4328-4334.
[10]Wu FZ,Huang YL,Wang YC,et al. Impact of location of epicardial adipose tissue,measured by coronary artery calcium-scoring computed tomography on obstructive coronary artery disease[J].Am J Cardiol,2013,112(7):943-949. DOI:10. 1016/j. amjcard. 2013. 05. 022.
[11]Siontis GC,Stefanini GG,Mavridis D,et al. Percutaneous coronary interventional strategies for treatment of in-stent restenosis:a network meta-analysis[J]. Lancet,2015,386(9994):655-664.DOI:10. 1016/S0140-6736(15)60657-2.
[12]解金红,李靖,关怀敏.冠状动脉支架内再狭窄相关因素研究[J].中国医师杂志,2006,8(11):1505-1506. DOI:10.3760/cma. j. issn. 1008-1372. 2006. 11. 025.
[13]Byrne RA,Joner M,Kastrati A. Stent thrombosis and restenosis:what have we learned and where are we going? The Andreas Grüntzig Lecture ESC 2014[J]. Eur Heart J,2015,36(47):3320-3331. DOI:10. 1093/eurheartj/ehv511.
[14]Tsay IM,Asrar u HM,Hayat U,et al. Neoatherosclerosis--a cause of late stent thrombosis?[J]. Int J Cardiol,2014,177(1):e1-e3. DOI:10. 1016/j. ijcard. 2014. 07. 201.
[15]Wong HK,Tang F,Cheung TT,et al. Adrenomedullin and diabetes[J]. World J Diabetes,2014,5(3):364-371. DOI:10.4239/wjd. v5. i3. 364.
[16]Salazar J,Luzardo E,Mejías JC,et al. Epicardial Fat:Physiological,Pathological,and Therapeutic Implications[J]. Cardiol Res Pract,2016,2016:1291537. DOI:10. 1155/2016/1291537.
[17]Lin L,Knowlton AA. Innate immunity and cardiomyocytes in ischemic heart disease[J]. Life Sci,2014,100(1):1-8. DOI:10.1016/j. lfs. 2014. 01. 062.
[18]Gaborit B,Venteclef N,Ancel P,et al. Human epicardial adipose tissue has a specific transcriptomic signature depending on its anatomical peri-atrial,peri-ventricular,or peri-coronary location[J]. Cardiovasc Res,2015,108(1):62-73. DOI:10. 1093/cvr/cvv208.
[19]冯林兴,于波.支架内新生动脉粥样硬化的研究进展[J].中华心血管病杂志,2013,41(2):173-176. DOI:10. 3760/cma.j. issn. 0253-3758. 2013. 02. 018.
[20]Patel VB,Shah S,Verma S,et al. Epicardial adipose tissue as a metabolic transducer:role in heart failure and coronary artery disease[J]. Heart Fail Rev,2017,22(6):889-902. DOI:10.1007/s10741-017-9644-1.
[21]杨天贵,付鹏,牛铁生.血清胱抑素C对支架内再狭窄的预测价值[J].中国医师杂志,2017,19(5):725-728. DOI:10.3760/cma. j. issn. 1008-1372. 2017. 05. 023.