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目的 :探讨心外膜脂肪组织厚度(epicardial adipose tissue thickness,EATT)对冠状动脉粥样硬化性心脏病(coronary atherosclerotic heart disease,CAD)的预测价值,寻找无创诊断CAD的手段。方法 :134例疑诊为CAD的患者,经冠状动脉CT造影检查确诊为CAD 56例。采用超声检查测量患者的EATT,比较CAD(n=56)与非CAD(n=78)患者的暴露因素,用多因素二分类Logistic回归分析筛选CAD的独立预测因素,并用受试者工作特征(receiver operating characteristic,ROC)曲线评价EATT诊断CAD的效能。结果 :(1)CAD组与非CAD组的EATT分别为(6.45±1.71)mm和(4.89±1.41)mm,2组间差异有统计学意义(t=5.781,P<0.001)。(2)在校正了体质量指数(body mass index,BMI)、年龄、高血压、总胆固醇、低密度脂蛋白胆固醇(low density lipoprotein cholesterol,LDL-C)和CAD家族史等混杂因素的作用后,EATT与CAD间有独立相关性(OR=3.753,P<0.001)。(3)EATT预测CAD的ROC曲线下面积为0.760(P<0.001),以5.55 mm作为临界值,其诊断CAD的灵敏度、特异度和一致率分别为71.43%、71.80%和71.64%。结论:EATT与CAD发病独立相关,可用于CAD高危人群的初步筛查。
Objective: To investigate the predictive value of epicardial adipose tissue thickness (EATT) in patients with coronary atherosclerotic heart disease (CAD) and to find a means of noninvasive diagnosis of CAD. Methods: A total of 134 patients suspected of having CAD were diagnosed as CAD 56 by CT coronary angiography. EATT was measured by ultrasonography in patients with CAD (n = 56) and non-CAD (n = 78), and independent predictors of CAD were screened using a logistic regression analysis using multivariate logistic regression. Subjects’ receiver operating characteristic (ROC) curve to evaluate the efficacy of EATT in the diagnosis of CAD. Results: (1) The EATT of CAD group and non-CAD group were (6.45 ± 1.71) mm and (4.89 ± 1.41) mm, respectively. There was significant difference between the two groups (t = 5.781, P <0.001). (2) After adjusting for the effects of confounding factors such as body mass index (BMI), age, hypertension, total cholesterol, low density lipoprotein cholesterol (LDL-C) and CAD family history There was independent correlation between EATT and CAD (OR = 3.753, P <0.001). (3) The area under the ROC curve of EATT predictive CAD was 0.760 (P <0.001). The sensitivity, specificity and consistency of diagnostic CAD were 71.43%, 71.80% and 71.64% respectively with 5.55 mm as the critical value. Conclusion: EATT is independently related to the onset of CAD and can be used for primary screening of high risk population of CAD.