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[心外膜脂肪组织厚度与非阻塞性冠状动脉慢血流的相关性]

[Correlation between epicardial adipose tissue thickness and slow flow of non-obstructive coronary artery].

作者信息

Wu Q, Yang B

机构信息

Department of Cardiology, People's Hospital of Wuhan University, Wuhan 430060, China.

出版信息

Zhonghua Xin Xue Guan Bing Za Zhi. 2016 Nov 24;44(11):956-960. doi: 10.3760/cma.j.issn.0253-3758.2016.11.011.

Abstract

To investigate the correlation between epicardial adipose thickness and slow flow of non-obstructive coronary artery. Clinical data of patients with coronary angiography examination evidenced stenosis<50% in our department from May 2014 to May 2015 were retrospectively analyzed.According to the level of TIMI in angiography, patients were divided into slow blood flow group (TIMI Ⅰ-Ⅱ, =16) and normal blood flow group (TIMI Ⅲ, =127). All epicardial adipose thickness was determined by echocardiography and data of biochemical data (fibrinogen, whole blood viscosity at high shear rate, erythrocyte aggregation index, platelet count, and platelet aggregation rate) were also analyzed.Multivariate logistic regression analysis was used to identify whether epicardial adipose thickness was a risk factor for the occurrence of slow flow of non-obstructive coronary artery.A linear regression analysis was used to identify the correlation between epicardial adipose thickness and severity of slow flow of non-obstructive coronary artery.Receiver operating characteristic (ROC) curve was used to analyze the predicting value of epicardial adipose thickness on slow flow of non-obstructive coronary artery. The epicardial adipose thickness was significantly thicker in slow blood flow group than in normal blood flow group ((8.18±2.25) mm vs. (4.65±0.88) mm, <0.01). The plasma fibrinogen concentration((4.17±1.13) g/L vs.(2.29±0.92) g/L, <0.01), erythrocyte aggregation index (7.88±1.07 vs. 5.46±1.17, <0.01), platelet count ((274.1±8.6)×10/L vs.(215.3±72.3)×10/L, <0.01) and platelet aggregation rate ((0.81±0.11)% vs.(0.64±0.12)%, <0.01) were significantly higher in slow blood flow group than in normal blood flow group.Whole blood viscosity at high shear rate was similar between the two groups ((4.16±0.56) mPa·s vs.(3.88±0.51) mPa·s, >0.05). Multivariate logistic regression analysis showed that epicardial adipose thickness was a risk factor for slow flow of non-obstructive coronary artery(: 6.813, 95% 1.130-41.074, <0.05). Linear regression analysis showed that there was a negative association between epicardial adipose thickness and TIMI level of non-obstructive coronary artery (=0.802, =0.644, =-0.237, <0.01). ROC analysis showed that the accuracy of prediction of epicardial adipose thickness on coronary artery slow flow was high(area under the curve was 0.941, 95% 0.876-1.000, <0.01). When the thickness reached 6.1 mm, the prediction index was maximum (0.766), and the sensitivity was 0.813, and the specificity was 0.953. Epicardial adipose thickness is related to slow flow of non-obstructive coronary artery and epicardial adipose thickness can be used as a predictor for slow flow of non-obstructive coronary artery.

摘要

探讨心外膜脂肪厚度与非阻塞性冠状动脉慢血流之间的相关性。回顾性分析2014年5月至2015年5月在我科行冠状动脉造影检查且狭窄<50%患者的临床资料。根据血管造影时TIMI血流分级,将患者分为慢血流组(TIMIⅠ-Ⅱ级,n = 16)和正常血流组(TIMIⅢ级,n = 127)。所有患者均通过超声心动图测定心外膜脂肪厚度,并分析生化指标数据(纤维蛋白原、高切全血黏度、红细胞聚集指数、血小板计数及血小板聚集率)。采用多因素logistic回归分析确定心外膜脂肪厚度是否是非阻塞性冠状动脉慢血流发生的危险因素。采用线性回归分析确定心外膜脂肪厚度与非阻塞性冠状动脉慢血流严重程度之间的相关性。采用受试者工作特征(ROC)曲线分析心外膜脂肪厚度对非阻塞性冠状动脉慢血流的预测价值。慢血流组的心外膜脂肪厚度显著厚于正常血流组((8.18±2.25)mm比(4.65±0.88)mm,P<0.01)。慢血流组血浆纤维蛋白原浓度((4.17±1.13)g/L比(2.29±0.92)g/L,P<0.01)、红细胞聚集指数(7.88±1.07比5.46±1.17,P<0.01)、血小板计数((274.1±8.6)×10⁹/L比(215.3±72.3)×10⁹/L,P<0.01)及血小板聚集率((0.81±0.11)%比(0.64±0.12)%,P<0.01)均显著高于正常血流组。两组高切全血黏度相似((4.16±0.56)mPa·s比(3.88±0.51)mPa·s,P>0.05)。多因素logistic回归分析显示心外膜脂肪厚度是非阻塞性冠状动脉慢血流的危险因素(β:6.813,95%CI 1.130 - 41.074,P<0.05)。线性回归分析显示心外膜脂肪厚度与非阻塞性冠状动脉TIMI分级呈负相关(r = 0.802,P = 0.644,β = -0.237,P<0.01)。ROC分析显示心外膜脂肪厚度对冠状动脉慢血流的预测准确性较高(曲线下面积为0.941,95%CI 0.876 - 1.000,P<0.01)。当厚度达到6.1 mm时,预测指数最大(0.766),灵敏度为0.813,特异度为0.953。心外膜脂肪厚度与非阻塞性冠状动脉慢血流相关,心外膜脂肪厚度可作为非阻塞性冠状动脉慢血流的预测指标。

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