·848·北京大学学报(医学版)JOURNALOFPEKINGUNIVERSITY(HEALTHSCIENCES)Vo1．46No．6Dec．2014·论著·非冠心病胸痛患者心外膜脂肪与冠状动脉血流储备的相关性张沫，李昭屏，李卫虹，李丹，刘丽娜，冯新恒，高炜(北京大学第三医院心内科，卫生部心血管分子生物学与调节肽重点实验室，北京100191)[摘要]目的：分析非冠心病胸痛患者心外膜脂肪组织(epicardialadiposetissue，EAT)与冠状动脉血流储备(coro—naryflowreserve，CFR)的关系，探讨EAT厚度对诊断冠状动脉微循环障碍的价值。方法：冠状动脉造影或冠状动脉CT证实各冠状动脉血管直径狭窄<50％的非冠心病胸痛患者62例，经胸超声心动图测定EAT厚度及三磷酸腺苷负荷冠状动脉左前降支的CFR，分析EAT厚度与CFR的关系。结果：完成CFR测定者61例，平均CFR为2．98±0．67；其中出现冠状动脉微循环障碍，即CFR<3者34人(56％)，平均CFR为2．52±0．32；CFR≥3者27人(44％)，平均CFR为3．56±0．52。CFR<3组EAT厚度明显大于CFR≥3组[(3．4±0．8)mm'us．(2．3±0．6)mm，P<0．001]，EAT厚度与CFR呈显著负相关(r=一0．668，P<0．001)。Logistic回归分析显示，EAT厚度是冠状动脉微循环障碍的独立影响因素(OR=7．78，95％C／：2．44—24．79，P=0．001)。ROC曲线分析显示，EAT厚度>2．9mm判断冠状动脉微循环障碍(CFR<3)的敏感性为82．4％，特异性为92．3％(曲线下面积0．860，P<0．001)。结论：冠状动脉微循环障碍患者心外膜脂肪厚度增加，L-~b膜脂肪厚度是冠状动脉微循环障碍的独立影响因素；心外膜脂肪厚度>2．9mm预测冠状动脉微循环障碍具有较好的敏感性和特异性。[关键词】超声心动描记术；心外膜脂肪；冠状动脉血流储备；冠状动脉循环；微循环[中图分类号]R541[文献标志码]A[文章编号]1671—167X(2014)06-0848-06doi：10．3969／j．issn．1671—167X．2014．06．006CorrelationbetweenepicardialadiposetissueandcoronaryflowreserveincoronaryheartdiseasepatientswithnochestpainZHANGMo，LIZhao—ping，LIWei-hong，LIDan，LIULi-na，FENGXin．heng，GAOWei(DepartmentofCardiology，PekingUniversityThirdHospital；KeyLaboratoryofCardiovascularMolecularBiologyandRegulatoryPeptides，MinistryofHealth，Beijing100191，China)ABSTRACTObjective：Toassesswhetherepicardialadiposetissue(EAT)thicknessisassociatedwithcoronaryflowreserve(CFR)andcouldbeusedtodetectcoronarymicrovasculardysfunction．Methods：Weenrolled62nondiabeticpatientswhounderwentcomputedtomographyangiographyorinvasivecoro．naryangiographyandhadnoobstructivecoronaryarterydisease．CFRandEATthicknessweremeasuredbytransthoracicDopplerechocardiography(1TrDE)．Results：Inthestudy，atotalof62patientswereenrolled，echocardiographiccoronaryflowreservewereobtainedin61ofthepatientswithameanageof(59±10)years．34patients(56％)hadreducedCFR(CFR<3，2．52±0．32)suggestingmicrovascu．1ardysfunctionand27patients(44％)hadnormalCFR(CFR≥3，3．56-4-0．52)．EATthicknesswassignificantlyincreasedinthepatientswithmicrovasculardysfunctionascomparedwiththosewithoutI(3．4±0．8)mmus．(2．3±0．6)mm，P<0．001】．EATthicknesswasstronglyrelatedtoCFR(r=一0．668。P<0．001)．ByLogisticregressionanalysis，EATthicknesswastheindependentpredictorofcoronarymicrovasculardysfunction(DR=7．78，95％C／：2．44—24．79)．EATthickness>2．9mmhad82．4％sensitivityand92．3％specificitytodetectCFR<3(areaunderR0Ccurve0．860．P<0．001)．Conclusion：EATthicknesswassignificantlyincreasedinpatientswithcoronarymicrovasculardysfunction．EATthicknesswasindependentlyassociatedwithimpairedCFR．EAT>2．9mmhadhighsensitivityandspecificitytodetectcoronarymicrovasculardysfunction．KEYWORDSEchocardiography；Epicardialfat；Coronaryflowreserve；Coronarycirculation：Microcir．culation心外...
