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中华医学超声杂志（电子版）

中华医学超声杂志（电子版） ›› 2017, Vol. 14 ›› Issue (03) : 186 -192. doi: 10.3877/cma.j.issn.1672-6448.2017.03.006

所属专题： 文献；

心血管超声影像学

超声测量的心外膜脂肪厚度与心房颤动的相关性
张梅青1, 李越2,†(), 王秋霜1, 翟亚楠2, 魏丽群2, 黄党生1   
  1. 1. 100048　北京，解放军总医院第一附属医院心内科
    2. 100853　北京，解放军总医院超声科
  • 收稿日期:2016-06-04 出版日期:2017-03-01
  • 通信作者: 李越

The correlation of epicardial adipose tissue thickness and atrial fibrillation by echocardiography

Meiqing Zhang1, Yue Li2,†(), Qiushuang Wang1, Yanan Zhai2, Liqun Wei2, Dangsheng Huang1   

  1. 1. Department of Cardiology, First Affiliated Hospital of Chinese People′s Liberation Army General Hospital, Beijing 100048, China
    2. Department of Ultrasonography, Chinese People′s Liberation Army General Hospital, Beijing 100853, China
  • Received:2016-06-04 Published:2017-03-01
  • Corresponding author: Yue Li
  • About author:
    Corresponding author: Li Yue, Email:
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引用本文：

张梅青, 李越, 王秋霜, 翟亚楠, 魏丽群, 黄党生. 超声测量的心外膜脂肪厚度与心房颤动的相关性[J]. 中华医学超声杂志（电子版）, 2017, 14(03): 186-192.

Meiqing Zhang, Yue Li, Qiushuang Wang, Yanan Zhai, Liqun Wei, Dangsheng Huang. The correlation of epicardial adipose tissue thickness and atrial fibrillation by echocardiography[J]. Chinese Journal of Medical Ultrasound (Electronic Edition), 2017, 14(03): 186-192.

目的

探讨超声测量的心外膜脂肪（EAT）厚度与心房颤动（简称房颤）的相关性。

方法

选取2014年3月至2016年6月解放军总医院第一附属医院收治的房颤患者138例，其中阵发性房颤患者87例，持续性房颤患者51例，另选取窦性心律患者112例作为对照。超声测量所有患者EAT厚度，并记录常规参数。采用单因素方差分析比较阵发性房颤组、持续性房颤组与窦性心律组患者EAT厚度，进一步组间两两比较采用LSD-t检验；采用多因素Logistic回归分析分析房颤发生的危险因素；绘制EAT厚度、左心房内径（LAD）预测房颤发生的操作者工作特征（ROC）曲线；采用Pearson相关分析法分析EAT厚度与LAD的相关性。

结果

持续性房颤组、阵发性房颤组、窦性心律组患者EAT厚度分别为（4.75±1.83）、（4.32±1.76）、（1.38±0.68） mm。持续性房颤组、阵发性房颤组患者EAT厚度均大于窦性心律组患者，且差异均有统计学意义（t=-9.541、-11.439，P均<0.01）；Logistic回归分析结果显示，EAT厚度、LAD是房颤发生的独立危险因素（OR=3.17，95%CI 1.31~7.68，P<0.01；OR=2.65，95%CI 1.69~4.15，P<0.05）；ROC曲线显示，EAT厚度、LAD预测房颤发生的曲线下面积分别为0.784、0.865，最佳阈值分别为4.45 mm、40.00 mm；Pearson相关分析结果显示，EAT厚度与LAD呈显著正相关（r=0.512，P<0.01）。

结论

超声测量的EAT厚度的增加与房颤的发生显著相关，是房颤发生的独立危险因素之一,对预测房颤发生有一定的临床价值。

关键词: 心外膜脂肪, 心房颤动, 超声心动描计术
Objective

To investigate the association between atrial fibrillation (AF) and epicardial adipose tissue (EAT) by echocardiography.

Methods

One hundred and thirty-eight patients of AF in First Affiliated Hospital of Chinese People′s Liberation Army General Hospital from March 2014 to June 2016 were divided into two groups, including paroxysmal AF group with 87 casesand persistent AF group with 51 cases, and 112 cases of sinus rhythm were chosen as control group. Epicardial adipose tissue was measured using echocardiography in all patients, and the conventional parameters were recorded. One-way analysis of variance was used to compare the thickness of EAT in patients with paroxysmal AF group, persistent AF group and sinus rhythm group, and LSD-t test was used in further comparison between two groups. Multivariable logistic regression analysis was used to analyze the risk factors of AF. The receiver-operating characteristic (ROC) cure of EAT and left atrium diameter (LAD) were drawn to predict the incidence of AF. The correlation between EAT thickness and LAD was analyzed by Pearson correlation analysis.

Results

The thickness of EAT in patients with persistent AF, paroxysmal AF and sinus rhythm group were (4.75±1.83), (4.32±1.76) and (1.38±0.68) mm, respectively. Epicardial adipose tissue was significantly larger in paroxysmal AF and persistent AF patients compared with that of sinus rhythm group, and the differences were statistically significant (t=-9.541, -11.439, both P<0.01). Logistic regression analysis indicated that EAT thickness and LAD were independent risk factors of atrial fibrillation (odds ratio: 3.17, 95% confidence interval: 1.31-7.68, P<0.01; odds ratio: 2.65, 95% confidence interval 1.69-4.15, P<0.05). The area under the curve (AUC) of EAT and LAD to predict presence of AF were 0.784 and 0.865, and the best threshold value were 4.45 mm and 40.00 mm, respectively. Pearson correlation analysis showed that the EAT thickness and LAD had significantly positive correlation (r=0.512, P<0.01).

Conclusions

The increase of EAT thickness is significantly correlated with the incidence of AF and is independent to traditional risk factors. Therefore, the increase of EAT thickness has certain clinical value to predict AF.

Key words: Epicardial adipose tissue, Atrial fibrillation, Echocardiography
图2 超声测量房颤患者右心室前壁外心外膜脂肪略厚
表1 窦性心律组、阵发性房颤组、持续性房颤组患者一般临床资料及EAT厚度比较
组别 例数 年龄（岁，±s） 性别（例，男性/女性） 高血压[例（%）] 糖尿病[例（%）] 冠心病[例（%）] BMI（±s） LVEF（±s）
窦性心律组 112 68.2±10.6 67/45 49（44） 31（28） 29（25） 25.9±8.3 56.5±8.9
阵发性房颤组 87 68.3±11.1 56/31 42（59） 28（35） 25（29） 25.1±3.3 57.5±10.7
持续性房颤组 51 70.5±10.7 24/27 27（62） 18（32） 16（32） 24.9±3.6 55.2±7.3
F值 ? 0.927 0.165 1.803 1.927 0.343 0.165 0.987
P值 ? 0.162 0.902 0.073 0.064 0.220 0.902 0.260
组别 例数 LAD（mm，±s） LDL-C（mmol/L，±s） HDL-C（mmol/L，±s） TG（mmol/L，±s） CHO（mmol /L，±s） EAT（mm，±s）
窦性心律组 112 31.5±3.8a 2.73±0.84 1.25±0.27c 1.31±0.70 4.63±1.10 1.38±0.68d
阵发性房颤组 87 41.3±4.9 2.82±0.58 1.13±0.45 1.33±0.67 4.71±0.98 4.32±1.76
持续性房颤组 51 43.8±4.7b 2.69±0.34 1.10±0.48 1.14±0.51 4.59±1.20 4.75±1.83
F值 ? 70.520 1.756 6.087 0.336 0.649 35.958
P值 ? <0.001 0.087 0.026 0.785 0.413 <0.001
表2 房颤发生危险因素的Logistic回归分析
项目 B SE Wald值 OR值（95%CI） P值
年龄 0.05 0.06 0.86 1.06（0.94~1.12） 0.052
性别 0.19 0.03 0.52 0.76（0.31~1.95） 0.774
高血压 0.28 1.28 0.05 1.32（0.12~16.1） 0.828
冠心病 0.92 0.40 0.12 2.72（1.10~10.38） 0.634
糖尿病 -0.34 0.14 2.33 0.71（0.02~22.33） 0.710
BMI -0.19 0.20 0.85 0.83（0.94~1.12） 0.355
LVEF 0.82 0.64 0.97 1.05（0.93~1.14） 0.625
LAD>40 mm 0.97 0.23 18.2 2.65（1.69~4.51） 0.010
EAT厚度 1.12 0.45 6.55 3.17（1.31~7.68） 0.000
LDL-C 0.13 0.73 0.39 2.36（0.55~20.5） 0.530
HDL-C -0.56 0.38 0.20 -0.05（-2.47~1.62） 0.061
TG 0.85 0.32 0.26 1.13（0.26~5.73） 0.856
CHO 0.75 0.06 0.37 0.79（0.11~03.67） 0.242
图3 心外膜脂肪厚度、左心房内径预测房颤发生的操作者工作特征曲线。心外膜脂肪厚度、左心房内径预测房颤发生的最佳阈值分别为4.45 mm、40.00 mm，曲线下面积分别为0.784、0.865。心内膜脂肪厚度>4.45 mm预测房颤发生的敏感度、特异度分别为72.7%、65.3%，左心房内径>40.00 mm预测房颤发生的敏感度、特异度分别为83.5%、71.6%
图4 房颤患者心外膜脂肪厚度与左心房内径的相关性。心外膜脂肪厚度与左心房内径呈显著正相关（r=0.512，P<0.01）
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