Department of Internal Medicine, Seoul National University College of Medicine and Seoul National University Bundang Hospital, 300 Gumi-dong, Seongnam City, Gyeonggi-do 463-707, South Korea.
Radiology. 2011 Nov;261(2):437-45. doi: 10.1148/radiol.11101725. Epub 2011 Aug 26.
To investigate the prevalence and severity of subclinical coronary atherosclerosis and plaque characteristics in asymptomatic subjects according to the presence or absence of metabolic syndrome (MS) with multidetector computed tomography (CT).
This study was approved and the requirement for informed patient consent was waived by the local institutional review board. Degree of coronary artery stenosis, multivessel involvement, and plaque characteristics, as well as coronary artery calcium score (CACS), were assessed with 64-detector row CT in 3000 age- and sex-matched asymptomatic individuals (mean age, 50.2 years ± 8.9 [standard deviation]; age range, 30-79 years). Anthropometric and metabolic profiles were also measured. Multivariate logistic regression analyses were performed to identify variables related to coronary atherosclerosis and plaque types.
Subjects with MS had significant coronary artery stenosis (>50% stenosis), multivessel involvement, more positive remodeling, more atherosclerotic coronary segments, and higher CACS than subjects without MS (P < .01 for all). Mixed and noncalcified plaques were also more prominent in subjects with MS than in those without MS (14.2% ± 4.4 vs 7.6% ± 3.1 and 13.1% ± 4.3 vs 7.3% ± 2.8, respectively; P < .01 for both). After adjustment for confounding factors, MS was strongly associated with significant coronary artery stenosis, multivessel involvement, and mixed plaque.
Multidetector CT is useful in the early diagnosis and evaluation of subclinical coronary atherosclerosis in asymptomatic patients with MS; however, future prospective studies are needed to address the clinical implications of these findings.
使用多排螺旋 CT 研究代谢综合征（MS）患者与非 MS 患者亚临床冠状动脉粥样硬化的流行程度和严重程度以及斑块特征。
本研究经当地机构审查委员会批准，豁免了患者知情同意的要求。对 3000 名年龄和性别匹配的无症状个体（平均年龄 50.2 岁±8.9[标准差]；年龄范围 30-79 岁）进行 64 排螺旋 CT 评估，以评估冠状动脉狭窄程度、多支血管受累情况和斑块特征，以及冠状动脉钙评分（CACS）。还测量了人体测量和代谢特征。采用多变量逻辑回归分析确定与冠状动脉粥样硬化和斑块类型相关的变量。
MS 患者的冠状动脉狭窄程度（>50%狭窄）、多支血管受累、更多正性重构、更多粥样硬化冠状动脉节段和更高的 CACS 显著大于非 MS 患者（所有 P 值均<.01）。MS 患者的混合斑块和非钙化斑块也比非 MS 患者更为显著（14.2%±4.4%比 7.6%±3.1%和 13.1%±4.3%比 7.3%±2.8%；均 P<.01）。调整混杂因素后，MS 与显著冠状动脉狭窄、多支血管受累和混合斑块密切相关。
多排螺旋 CT 可用于早期诊断和评估 MS 无症状患者的亚临床冠状动脉粥样硬化；然而，需要进一步的前瞻性研究来解决这些发现的临床意义。
