Metabolic Clinic, Infectious and Tropical Diseases Unit, Department of Medicine, University of Modena and Reggio Emilia, Modena, Italy.
Am Heart J. 2012 Jun;163(6):1024-30. doi: 10.1016/j.ahj.2012.03.019.
Epicardial adipose tissue (EAT) may contribute to the development of coronary atherosclerosis via paracrine secretion of inflammatory cytokines.
This is a prospective, observational study of 240 consecutive HIV-infected patients receiving antiretroviral therapy. All patients underwent 2 sequential chest computed tomographic scans to assess the change in coronary artery calcium (CAC), a marker of subclinical atherosclerosis, and EAT volume. Patients with known cardiovascular disease were excluded. Factors independently associated with EAT change were explored using multivariable linear regression analyses. The association between EAT increase and CAC progression was explored using logistic regression analyses.
Two hundred forty patients were included. Patients' mean age was 47.5 ± 8 years, and 68% were men. The median interval between computed tomographic scans was 18.7 months (interquartile range 10-27 months). Men showed a larger increase in EAT (5 ± 14.2 cm(3)) than did women (-0.45 ± 8.8 cm(3), P = .007). Factors independently associated with change in EAT were CD4(+) recovery (β = 0.43, CI 0.05-0.82) and male gender (β = 5.65, CI, 1.05-10.26). Change in EAT was independently associated with CAC progression (odds ratio 1.04, 95% CI 1.004-1.88, P = .030) after adjusting for traditional cardiovascular risk factors.
In this cohort of patients with HIV receiving antiretroviral therapy, male gender and CD4(+) were independent predictors of EAT increase, and there was a parallel progression of CAC and EAT. Abnormal immunoreactivity associated with T-lymphocyte recovery should be further studied as a determinant of atherosclerosis progression in HIV-infected patients.
心外膜脂肪组织（EAT）可能通过旁分泌炎性细胞因子促进冠状动脉粥样硬化的发展。
这是一项对 240 例连续接受抗逆转录病毒治疗的 HIV 感染患者的前瞻性、观察性研究。所有患者均接受 2 次连续胸部 CT 扫描，以评估冠状动脉钙（CAC）的变化，CAC 是亚临床动脉粥样硬化的标志物，以及 EAT 体积。排除已知心血管疾病的患者。使用多变量线性回归分析探讨与 EAT 变化相关的独立因素。使用逻辑回归分析探讨 EAT 增加与 CAC 进展之间的关系。
240 例患者入选。患者平均年龄为 47.5 ± 8 岁，68%为男性。两次 CT 扫描之间的中位间隔为 18.7 个月（四分位间距为 10-27 个月）。男性 EAT 增加（5 ± 14.2 cm3）明显大于女性（-0.45 ± 8.8 cm3，P =.007）。与 EAT 变化相关的独立因素包括 CD4+恢复（β = 0.43，CI 0.05-0.82）和男性（β = 5.65，CI 1.05-10.26）。调整传统心血管危险因素后，EAT 的变化与 CAC 进展独立相关（比值比 1.04，95%CI 1.004-1.88，P =.030）。
在接受抗逆转录病毒治疗的 HIV 患者队列中，男性和 CD4+是 EAT 增加的独立预测因素，CAC 和 EAT 呈平行进展。与 T 淋巴细胞恢复相关的异常免疫反应应进一步研究，作为 HIV 感染患者动脉粥样硬化进展的决定因素。
