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: ①CAD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)。③EATT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 explore the predictive value of epicardial adipose tissue thickness (EATT) for coronary artery disease (CAD) as a non-invasive approach for predicting CAD. Methods: A total of 134 cases with suspected CAD were enrolled,and 56 patients were diagnosed as CAD by coronary computerized tomographic angiography (CTA). EATT was measured by ultrasonography. The predictive factors were compared between the patients with CAD (CAD group, n=56) and patients without CAD (non-CAD group, n=78). Multivariate logistic regression analysis was used to screen the independent predictive factors of CAD. The receiver operating characteristic(ROC) curve was used to evaluate the diagnostic value of EATT for CAD. Results: The EATT of CAD group and non-CAD group were (6.45±1.71) mm and (4.89±1.41) mm, respectively (t=5.781, P<0.001). After adjusting the confounding factors, such as body mass index (BMI), age,hypertension, total cholesterol (TC), low density lipoprotein cholesterol (LDL-C) and family history of CAD, EATT was independently associated with CAD(OR=3.753, P=0.001). The area under the ROC curve of EATT for diagnosis of CAD was 0.760(P=0.001), and when 5.55 mm was taken as the cut-off point, the specificity, sensitivity and accuracy were 71.43%, 71.80% and 71.64%, respectively. Conclusions: EATT is independently associated with CAD, it can be used as a preliminary screening test for subjects at a high risk of CAD.
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