發(fā)布時間：2018-07-21 17:48

【摘要】：目的：探討心外膜脂肪組織(EAT)體積與非瓣膜性心房顫動(簡稱房顫)患者血栓栓塞間的關(guān)系方法：入選155例2012年-2015年于本院住院治療的非瓣膜性房顫患者。使用螺旋CT掃描技術(shù)半手動測定所有患者的總心外膜脂肪體積及左心房周心外膜脂肪體積,同時記錄左心房內(nèi)徑、基線資料、伴發(fā)疾病情況及抗凝藥物使用情況。根據(jù)既往有無房顫相關(guān)的缺血性腦卒中、短暫性腦缺血發(fā)作(TIA)及體循環(huán)栓塞病史將研究對象分為栓塞組和非栓塞組,比較兩組各指標間的差異,探討房顫患者心外膜脂肪組織與栓塞事件間的關(guān)系。155例患者中95例未接受抗凝治療患者納入房顫組,另選取50例年齡、BMI及房顫病程相匹配者作為正常對照組,收集紅細胞比積、血小板平均體積、D-二聚體和纖維蛋白原(FIB)等凝血狀態(tài)指標,測定總心外膜脂肪體積及左心房周心外膜脂肪體積,比較兩組凝血狀態(tài)指標間的差異,并分析房顫患者中凝血指標與心外膜脂肪體積的相關(guān)性。結(jié)果：(1)合并高血壓、糖尿病、血管疾病、冠心病的房顫患者較未合并者具有明顯升高EAT及EAT-LA體積,單因素相關(guān)性分析顯示EAT及LA-EAT體積與年齡CHA2DS2-VASc評分正相關(guān)(2)心外膜脂肪組織與栓塞事件：155例中,22例發(fā)生缺血性腦卒中或短暫性腦缺血發(fā)作(TIA)、體血環(huán)栓塞的房顫患者被納入了栓塞事件組(平均年齡62.50±10.42歲,女性7例),余133例作為對照組(平均年齡54.45±10.81歲,女性38例)。研究發(fā)現(xiàn)與非栓塞事件組患者相比,栓塞事件組患者擁有更大的左心房內(nèi)徑、更高平均年齡及CHA2DS2-VASc評分，而在性別、體質(zhì)量指數(shù)(BMI)、高血壓、糖尿病、冠心病等伴發(fā)疾病及血脂水平等方面兩組患者間未見明顯差異。血栓栓塞事件組患者的EAT及LA-EAT體積較對照組明顯增加(123.49±31.25 cm3 vs.100.55±35.36 cm3, P=0.005; 34.22±6.84 cm3 vs.27.10±9.55 cm3, P0.001).多因素相關(guān)性分析提示在矯正了CHA2DS2-VASc評分等混雜因素的情況下,EAT (OR=1.10,P=0.039)及LA-EAT (OR=1.10,P=0.024)均為房顫患者血栓栓塞之間的獨立危險因素。(3)房顫組心外膜脂肪體積較正常對照組明顯增高,同時相較正常對照組,房顫組具有更高的D-二聚體[0.26(0.21-0.41)vs 0.22(0.17-0.29),P0.001]和纖維蛋白原[2.85(2.46-3.83)vs2.69(2.42-3.36),P0.001]。相關(guān)性分析提示心外膜脂肪組織體積與D-二聚體和纖維蛋白原水平獨立相關(guān)。結(jié)論：(1)積聚的心外膜脂肪組織與房顫血栓栓塞危險因素間關(guān)系密切,合并有高血壓、糖尿病、冠心病、血管疾病及高齡等房顫血栓栓塞危險因素的房顫患者具有更大的心外膜脂肪體積。(2)心外膜脂肪組織體積是房顫患者血栓栓塞的獨立危險因素,積聚的心外膜脂肪組織可能促進了房顫患者血栓栓塞的發(fā)生。(3)非瓣膜性房顫患者較正常人群具有明顯的血栓前狀態(tài),心外膜脂肪體積與房顫患者血栓前狀態(tài)間存在相關(guān)性。
[Abstract]:Objective: to investigate the relationship between the volume of epicardial adipose tissue (EAT) and thromboembolism in patients with non-valvular atrial fibrillation (AF). The total epicardial fat volume and epicardial fat volume of left atrium were measured by semi-manual spiral CT scanning. The diameter of left atrium, baseline data, associated diseases and anticoagulant use were recorded. According to the history of transient ischemic attack (TIA) and systemic circulation embolism, the subjects were divided into embolization group and non-embolization group, and the differences between the two groups were compared. To explore the relationship between epicardial adipose tissue and embolism events in patients with atrial fibrillation. 95 of 155 patients without anticoagulant therapy were included in the atrial fibrillation group. 50 patients with age-matched BMI and course of atrial fibrillation were selected as the normal control group to collect hematocrit. The mean platelet volume and coagulation state indexes such as D-dimer and fibrinogen (FIB), total epicardial fat volume and left atrial pericardial epicardial fat volume were measured, and the difference of coagulation state between the two groups was compared. The correlation between coagulation parameters and epicardial fat volume in patients with atrial fibrillation was analyzed. Results: (1) Atrial fibrillation patients with hypertension, diabetes, vascular disease and coronary heart disease had significantly higher volume of eat and EAT-LA than those without. Univariate correlation analysis showed that the volumes of eat and LA-EAT were positively correlated with age CHA2DS2-VASc scores (2) epicardial adipose tissue and embolism events occurred in 22 out of 155 patients with ischemic stroke or transient ischemic attack (TIA) and atrial fibrillation with systemic blood ring embolism. Patients were enrolled in the embolization event group (mean age 62.50 鹵10.42 years). The remaining 133 cases were used as control group (mean age 54.45 鹵10.81 years, female 38 cases). The study found that patients in the event group had greater left atrial diameter, higher average age and CHA2DS2-VASc score than those in the non-embolism event group, while gender, body mass index (BMI), hypertension, diabetes. There was no significant difference in coronary heart disease and blood lipid level between the two groups. The volume of eat and LA-EAT in the thromboembolism group was significantly higher than that in the control group (123.49 鹵31.25 cm3 vs.100.55 鹵35.36 cm 3, P < 0.005; 34.22 鹵6.84 cm3 vs.27.10 鹵9.55 cm 3, P 0.001). Multivariate correlation analysis showed that EAT (OR1. 10 P0. 039) and LA-EAT (OR1. 10 P0. 024) were independent risk factors between thromboembolism in patients with atrial fibrillation. (3) epicardial fat volume in AF group was significantly higher than that in normal control group. At the same time, atrial fibrillation group had higher D-dimer [0.26 (0.21-0.41) vs 0.22 (0.17-0.29) P0.001] and fibrinogen [2.85 (2.46-3.83) vs2.69 (2.42-3.36) P0.001]. Correlation analysis showed that the volume of epicardial adipose tissue was independent of D-dimer and fibrinogen levels. Conclusion: (1) the accumulation of epicardial adipose tissue is closely related to the risk factors of thromboembolism in atrial fibrillation. Vascular disease and elderly patients with atrial fibrillation with thromboembolism risk factors have greater epicardial fat volume. (2) epicardial adipose tissue volume is an independent risk factor for thromboembolism in patients with atrial fibrillation. The accumulation of epicardial adipose tissue may promote the occurrence of thromboembolism in patients with atrial fibrillation. (3) Non-valvular atrial fibrillation patients have significant prethrombotic state, and there is a correlation between epicardial fat volume and prethrombotic state in patients with atrial fibrillation.
【學(xué)位授予單位】：中國人民解放軍醫(yī)學(xué)院
【學(xué)位級別】：碩士
【學(xué)位授予年份】：2016
【分類號】：R541.75

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