摘要
目的 探讨冠状动脉CT血管成像(CCTA)分析类风湿关节炎(RA)伴冠心病患者冠周脂肪组织(PCAT)特征及脂代谢与高危斑块的关系。方法 回顾性分析2020年1月至2024年1月河北北方学院附属第一医院收治的150例RA伴冠心病患者的临床资料,根据斑块特征,将发生高危斑块的患者纳入高危组(62例),其余患者则纳入非高危组(88例),所有患者均进行CCTA检查,测量患者的PCAT特征,并检测脂代谢指标。比较两组PCAT特征、脂代谢指标,使用Pearson法分析PCAT特征与脂代谢的关系,通过多因素logistic回归分析筛选RA伴冠心病患者发生高危斑块的影响因素。采用受试者操作特征(ROC)曲线分析PCAT特征、脂代谢指标对高危斑块的预测价值。结果 与非高危组比较,高危组患者中冠状动脉狭窄程度为重度的比例、低密度脂蛋白胆固醇(LDL-C)水平更高,高密度脂蛋白胆固醇(HDL-C)水平更低(P<0.05)。与非高危组比较,高危组左前降支(LAD)-脂肪衰减指数(FAI)、左旋支(LCX)-FAI更高,LAD-PCAT体积更低(P<0.05)。Pearson相关分析显示,LAD-FAI、LCX-FAI与LDL-C呈正相关(r=0.482、0.501,P<0.001),与HDL-C呈负相关(r=-0.615、-0.607,P均<0.001);LAD-PCAT体积与LDL-C呈负相关(r=-0.610,P<0.001),与HDL-C呈正相关(r=0.512,P<0.001)。多因素logistic回归分析显示,LAD-FAI、LCX-FAI、LDL-C高是RA伴冠心病患者发生高危斑块的独立危险因素(P<0.05),LAD-PCAT体积、HDL-C高则是其独立保护因素(P<0.05)。ROC曲线分析显示,LAD-FAI、LCX-FAI、LAD-PCAT体积、HDL-C、LDL-C单独预测高危斑块的曲线下面积(95%CI)分别为0.656(0.574~0.731)、0.622(0.539~0.700)、0.629(0.546~0.706)、0.777(0.701~0.840)、0.827(0.757~0.884),联合预测的曲线下面积(95%CI)为0.910(0.853~0.951),联合预测的效能更高(P<0.05)。结论 PCAT特征(LAD-FAI、LCX-FAI、LAD-PCAT体积)与脂代谢(HDL-C、LDL-C)及高危斑块密切相关,均为高危斑块的影响因素,PCAT特征联合脂代谢对于高危斑块具有较高的预测价值。
Objective To explore the characteristics of pericoronary adipose tissue(PCAT)in patients with rheumatoid arthritis(RA)complicated with coronary heart disease by coronary computed tomography angiography(CCTA)and its relationship with lipid metabolism and the progression of high-risk plaques.Method A retrospective analysis was conducted on the clinical data of 150 patients with RA complicated with coronary heart disease admitted to Hebei North University Affi liated First Hospital from January 2020 to January 2024.All patients underwent CCTA examination.According to the characteristics of the plaques,patients with highrisk plaques were included in the high-risk group(62 cases),while the remaining patients were included in the non-high-risk group(88 cases).Measure the characteristics of the PCAT of the patients,detect the lipid metabolism indicators of the patients,and compare the characteristics of the PCAT and the lipid metabolism indicators of the two groups.The Pearson method was used to analyze the relationship between the characteristics of PCAT and lipid metabolism.Multivariate Logistic regression was employed to investigate the infl uencing factors of high-risk plaques in patients with RA and coronary heart disease.The predictive value of the characteristics of PCAT and lipid metabolism indicators for the progression of high-risk plaques was analyzed using the receiver operating characteristic(ROC)curve.Result Compared with the non-high-risk group,the high-risk group had a higher proportion of severe coronary artery stenosis and low-density lipoprotein cholesterol(LDL-C),and a lower high-density lipoprotein cholesterol(HDL-C)(P<0.05).Compared with the non-high-risk group,the high-risk group had higher left anterior descending artery(LAD)-fat attenuation index(FAI),left circumfl ex artery(LCX)-FAI,and lower LAD-PCAT volume(P<0.05).The results of the Pearson analysis indicated that LAD-FAI and LCX-FAI were positively correlated with LDL-C values(r=0.482,r=0.501,both P<0.001);LAD-FAI and LCX-FAI were negatively correlated with HDL-C(r=-0.615,r=-0.607,both P<0.001);the volume of LAD-PCAT was negatively correlated with LDL-C(r=-0.610,P<0.001)and positively correlated with HDL-C(r=0.512,P<0.001).The results of multivariate Logistic regression analysis showed that high LAD-FAI,high LCX-FAI,and high LDL-C were risk factors for the occurrence of high-risk plaques in RA patients with coronary heart disease(P<0.05),while high LAD-PCAT volume and high HDL-C were protective factors(P<0.05).The results of the ROC curve analysis showed that the areas under the curve(AUC)for individual predictors of high-risk plaques,namely LAD-FAI,LCX-FAI,LAD-PCAT volume,HDL-C,and LDL-C,were 0.656(0.574-0.731),0.622(0.539-0.700),0.629(0.546-0.706),0.777(0.701-0.840),and 0.827(0.757-0.884)respectively.The AUC for the combined predictors was 0.910(0.853-0.951),indicating a higher combined predictive effi cacy(P<0.05).Conclusion The PCAT features(LAD-FAI,LCXFAI,LAD-PCAT volume)are closely related to lipid metabolism(HDL-C,LDL-C)and high-risk plaques,and are all influencing factors of high-risk plaques.The combination of PCAT features and lipid metabolism has a high predictive value for high-risk plaques.
作者
刘兰
张玉姣
马朝磊
张兰
刘晓城
邹殿俊
朱晓龙
赵悦
Liu Lan;Zhang Yujiao;Ma Chaolei;Zhang Lan;Liu Xiaocheng;Zou Dianjun;Zhu Xiaolong;Zhao Yue(Department of Medical Imaging,Hebei North University Affiliated First Hospital,Zhangjiakou Hebei 075000,China;Department of Rheumatology and Immunology,Hebei North University Affi liated First Hospital,Zhangjiakou Hebei 075000,China)
出处
《中国医刊》
2026年第1期54-59,共6页
Chinese Journal of Medicine
基金
河北省医学科学研究课题(20241016)。
关键词
类风湿关节炎
冠心病
冠状动脉CT血管成像
冠周脂肪组织特征
脂代谢
高危斑块
Rheumatoid arthritis
Coronary heart disease
Coronary computed tomography angiography
Characteristics of pericoronary adipose tissue
Lipid metabolism
High-risk plaque
