【摘要】：研究目的:觀察接受冠狀動(dòng)脈介入治療(percutaneous coronary intervention,PCI)的冠心病患者1年內(nèi)其主要不良心血管事件(major adverse cardiovascular events,MACE),探討心外膜脂肪組織(epicardial adipose tissue,EAT)與冠心病患者PCI術(shù)后預(yù)后的關(guān)系,評(píng)估心外膜脂肪組織在冠心病患者發(fā)病與臨床預(yù)后中的價(jià)值,為改善PCI術(shù)后患者的臨床預(yù)后提供新的靶點(diǎn)。研究方法:本研究前瞻性入選2013年12月-2014年11月到泰達(dá)國(guó)際心血管病醫(yī)院內(nèi)一科接受冠狀動(dòng)脈介入治療的冠心病患者237例,于PCI術(shù)前通過(guò)多排平掃CT(multi-sclice CT,MSCT)測(cè)量心外膜脂肪組織容積(epicardial adipose tissue volume,EATV),根據(jù)入選者EATV測(cè)量結(jié)果將其分為三組,分別為A組(EATV"f75cm3),B組(75cm3EATV150cm3),C組(EATV"g150cm3)。分別化驗(yàn)三組患者血清的血脂、血糖、白細(xì)胞介素(interleukin,IL)-6、腫瘤壞死因子(tumor necrosis factor,TNF)-α、超敏C反應(yīng)蛋白(hypersensitive c-reactive protein,Hs-CRP)以及脂聯(lián)素水平。待各項(xiàng)檢查完善后,如果沒(méi)有冠脈造影(Coronar Angiography,CAG)禁忌癥,安排擇期行CAG及PCI術(shù)。分析評(píng)估EATV水平與炎性因子及冠狀動(dòng)脈粥樣硬化性心臟病(coronary heart disease,CHD)常規(guī)危險(xiǎn)因素間的關(guān)系,同時(shí)隨訪觀察所有入選病人1年內(nèi)的MACE發(fā)生的數(shù)量,探討EATV水平與PCI術(shù)后患者M(jìn)ACE發(fā)生的相關(guān)性。研究結(jié)果:將A、B、C三組的一般資料進(jìn)行比較可見(jiàn),三組在年齡、性別、合并高血壓、合并糖尿病、吸煙情況、空腹血糖、TC、TG、LDL及HDL水平方面差異無(wú)統(tǒng)計(jì)學(xué)意義(p0.05),而從BMI、hs-CRP、IL-6、TNF-α方面比較:B組水平高于A組,C組水平分別高于A、B兩組,三組差異具有統(tǒng)計(jì)學(xué)意義(p0.01或p0.05)。而脂聯(lián)素水平比較A組高于B、C兩組,B組高于C組,三組差異具有顯著統(tǒng)計(jì)學(xué)意義(p0.01)。然后從上述五個(gè)有統(tǒng)計(jì)學(xué)意義的指標(biāo)出發(fā),與患者EATV水平做Spearman二變量相關(guān)分析,結(jié)果顯示:EATV與hs-CRP,IL-6,TNF-α呈顯著正相關(guān)(r=0.675~0.700,p0.01),與脂聯(lián)素呈顯著負(fù)相關(guān)(r=-0.629,p0.01),而與BMI有較弱的正相關(guān)性(r=0.410,p0.01)。分別記錄三組患者M(jìn)ACE發(fā)生的數(shù)量,并進(jìn)行比較,數(shù)量從高到低依次為C、B、A組,三組具有顯著的統(tǒng)計(jì)學(xué)意義(p0.01),然后將EATV水平與MACE的發(fā)生做ROC曲線,ROC曲線分析:EATV水平預(yù)測(cè)MACE事件發(fā)生的曲線下面積為0.779(95%CI:0.669~0.889,p0.01),界值為116.11cm3,敏感性和特異性分別為86.4%,60%,可見(jiàn)EATV水平對(duì)MACE的發(fā)生具有良好的預(yù)測(cè)價(jià)值.最后,將MACE事件的發(fā)生與冠心病常見(jiàn)危險(xiǎn)因子行l(wèi)ogistic回歸分析得知:EATV116.11cm3(OR=4.584,p0.01),多支病變(OR=3.416,p0.05)及不完全血運(yùn)重建(OR=1.103,p0.05)是PCI術(shù)后MACE事件發(fā)生的獨(dú)立危險(xiǎn)因素。研究結(jié)論:EAT作為一個(gè)內(nèi)臟脂肪組織的代表可分泌大量的CRP,白細(xì)胞介素-6,TNF-α等炎性因子,這些因子共同抑制脂聯(lián)素的分泌。EATV水平與PCI術(shù)后患者M(jìn)ACE事件的發(fā)生密切相關(guān),且EATV116.11cm3,多支病變及不完全血運(yùn)重建是PCI術(shù)后患者1年內(nèi)發(fā)生MACE的獨(dú)立危險(xiǎn)因素,可以用于評(píng)估及預(yù)測(cè)冠心病患者PCI術(shù)后的預(yù)后情況,其將不僅在學(xué)術(shù)研究中受到青睞,也為將來(lái)心血管疾病的治療提供新的靶點(diǎn)。
[Abstract]:Objective: To study the relationship between epicardial adipose tissue (EAT) and prognosis after PCI in patients with coronary heart disease (CHD) undergoing coronary intervention (PCI). To evaluate the value of epicardial adipose tissue in the pathogenesis and prognosis of coronary heart disease, and to provide a new target for improving the clinical prognosis of patients with PCI. Methods: In this study,237 patients with coronary heart disease treated with coronary intervention were prospectively selected from December 2013 to November 2014, and the epicardial adipose tissue volume (EATV) was measured by multi-scan CT (MSCT) before PCI. The results of the EATV measurements were divided into three groups, respectively (EATV "f75cm3, Group B (75cm3EATV150cm3), Group C (EATV" g150cm3). Blood lipids, blood glucose, interleukin (IL)-6, tumor necrosis factor (TNF)-1, hypersensitive C-reactive protein (Hs-CRP) and adiponectin levels in the serum of three groups were tested. After the examination and improvement, if there was no contraindication of coronary angiography (CAG), the patients were scheduled for CAG and PCI. The relationship between the level of EATV and the routine risk factors of the inflammatory and coronary heart disease (CHD) was assessed, and the number of MACE occurring within 1 year of all the enrolled patients was observed, and the correlation between the level of EATV and the MACE in patients after PCI was discussed. Results: The general data of group A, B and C were compared, and the difference of three groups in age, sex, combined hypertension, diabetes, smoking, fasting blood glucose, TC, TG, LDL and HDL was not significant (p0.05), and from BMI, hs-CRP, IL-6, Compared with group A and group B, group B was higher in group B than in group A and group B, and the difference of group B was statistically significant (p0.01 or p0.05). The level of adiponectin in group A was higher than that in group B and C, and group B was higher than that in group C. The results showed that EATV was positively correlated with hs-CRP, IL-6 and TNF-1 (r = 0.675-0.700, p0.01) and negatively correlated with adiponectin (r =-0.629, p0.01). However, there was a positive correlation with BMI (r = 0.410, p0.01). The number of MACE in the three groups was recorded, and the number of MACE in the three groups was compared. The number of MACE in the three groups was from high to low in order of C, B and A, and the three groups had significant statistical significance (p0.01), and then the ROC curve and the ROC curve of the EATV level and the MACE were analyzed. The EATV level predicted that the area of the MACE event was 0.779 (95% CI: 0.669-0.889, p0.01), the boundary value was 116.11 cm3, the sensitivity and specificity were 86.4% and 60%, respectively, and the visible EATV level had good predictive value for the occurrence of MACE. Finally, the occurrence of MACE events and the common risk factors of coronary heart disease were obtained by logistic regression analysis: EATV116.11 cm3 (OR = 4.584, p0.01), multiple lesions (OR = 3.416, p0.05) and incomplete revascularization (OR = 1.103, p0.05) were independent risk factors for the occurrence of MACE events after PCI. Conclusion: EAT, as a representative of visceral adipose tissue, can secrete a large amount of inflammatory factors such as CRP, interleukin-6, and TNF-1, which co-inhibit the secretion of adiponectin. The level of EATV is closely related to the occurrence of MACE in patients after PCI, and EATV116.11 cm3, multivessel disease and incomplete revascularization are independent risk factors of MACE within 1 year after PCI, and can be used to evaluate and predict the prognosis of patients with coronary heart disease after PCI. It will not only be favored in academic research, but also provide a new target for future treatment of cardiovascular disease.
【學(xué)位授予單位】：天津醫(yī)科大學(xué)
【學(xué)位級(jí)別】：碩士
【學(xué)位授予年份】：2016
【分類號(hào)】：R541.4

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