CT检测非酒精性脂肪性肝病合并高危冠状动脉斑块患者冠状动脉指标临床意义探讨*

doi:10.3969/j.issn.1672-5069.2022.03.020

摘要/Abstract

摘要： 目的探讨非酒精性脂肪性肝病(NAFLD)合并冠状动脉斑块患者CT检测的肝脏脂肪分数(HFF)的临床意义。方法 2015年1月～2021年1月我院诊治的NAFLD患者168例,均接受冠状动脉CT血管成像检查,在Syngo.via工作站基于双能CT基物质分解算法自动计算HFF。结果 168例NAFLD患者中,无冠状动脉斑块76例,存在冠状动脉斑块但不符合高危冠状动脉斑块(HRP) 者48例,HRP 44例;无斑块组、HRP阴性组和HRP组心外膜脂肪组织体积(EATV)分别为91.8(82.4,98.3)cm³、102.6(87.6,120.4)cm³和136.2(82.4,98.3)cm³,差异具有统计学意义(P<0.05),EAT CT值分别为-79.3(-81.2,-76.4)HU、-74.2(-77.3,-70.4)HU和-66.8(-70.5,-63.4)HU,差异具有统计学意义(P<0.05),冠状动脉周围脂肪组织(PAT) CT值分别为-79.0(-80.6,-76.3)HU、-73.1(-75.2,-70.2)HU和-66.2(-70.1,-63.0)HU,差异具有统计学意义(P<0.05);无斑块组、HRP阴性组和HRP组冠状动脉周围脂肪组织体积(PATV)分别为【17.5(15.5,18.6)cm³】、【17.4(15.7,21.8)cm³】和【18.9(17.5,23.1)cm³】,差异具有统计学意义(P<0.05);HFF分别为【6.8(5.3,9.2)%】、【8.8(7.0,12.6)%】和【15.4(12.3,17.8)%】,差异具有统计学意义(P<0.05);肝脏CT值分别为【(44.4±4.7)HU】、【(43.2±4.6)HU】和【(39.7±4.4)HU】比差异具有统计学意义(P<0.05);无斑块组、HRP阴性组和HRP组吸烟史、高血压、糖尿病、中性粒细胞/淋巴细胞比率(NLR)、HDL、TG、TC和Framingham危险评分等差异具有统计学意义(P<0.05);HRP阴性组与HRP组冠状动脉狭窄程度、低密度斑块、点状钙化斑块、重构指数和餐巾环征等差异具有统计学意义(P<0.05)。结论作为测定肝脏脂肪含量的新型非侵入性成像方法,CT检测HFF具有测量简便、可重复性好等优点,有助于优化对NAFLD患者合并心血管疾病的危险分层。

关键词: 非酒精性脂肪性肝病, 高危冠状动脉斑块, 冠状动脉血管成像, 肝脏脂肪分数

Abstract: Objective The aim of this study was to explore the implication of hepatic fat fraction (HFF) by CT angiography (CTA) in patients with nonalcoholic Fatty liver diseases (NAFLD) and high-risk coronary plaque (HRP). Methods 168 patients with NAFLD were admitted to our hospital between January 2015 and January 2021, and all underwent CTA check-up. The HFF was automatically given atSyngo.via station. Results Out of the 168 patients with NAFLD, there were no coronary plaque in 76 cases, with coronary plaque but not risk in 48 cases and with HRP in 44 cases; the epicardial adipose tissue volume (EATV) in plaque-free, HRP negative and HRP group were 91.8(82.4, 98.3)cm³, 102.6(87.6, 120.4)cm³ and 136.2(82.4, 98.3)cm³, significantly statistically different (P < 0.05); the CT values of EAT in the three groups were -79.3(-81.2, -76.4) HU, -74.2(-77.3, -70.4)HU and -66.8(-70.5, -63.4) HU, significantly different (P < 0.05); the CT values of pericoronary adipose tissue (PAT) were -79.0(-80.6, -76.3)HU, -73.1(-75.2, -70.2)HU and -66.2(-70.1, -63.0)HU, significantly different (P < 0.05); the PAT volume (PATV) were [17.5(15.5, 18.6)cm³], [17.4(15.7, 21.8)cm³] and [18.9(17.5, 23.1)cm³], significantly different(P<0.05) among the three groups; the HFF were [6.8(5.3, 9.2)%], [8.8(7.0, 12.6)%] and [15.4(12.3, 17.8)%], significantly different(P<0.05); the CT value of liver were [(44.4±4.7)HU], [(43.2±4.6)HU] and [(39.7±4.4)HU], significantly different(P<0.05); there were significant differences in smoking habit, blood hypertension, diabetes, neutrophil/lymphocyte ratio (NLR), HDL, TG, TC and Framingham risk score among the three groups(P<0.05); there were significant differences in coronary artery stenosis degree, low density plaque, punctate calcified plaque, remodeling index and napkin ring sign between patients with HRP negative and with HRP (P<0.05). Conclusion As a new non-invasive imaging marker for liver fat measurement, the HFF has the advantages of simple measurement and good repeatability, which might help optimize the cardiovascular risk stratification in patients with NAFLD.

Key words: Nonalcoholic fatty liver diseases, High-risk coronary plaque, CT angiography, Liver fat fraction

蔡冬梅, 吴文娟, 姜亦伦, 居敏昊. CT检测非酒精性脂肪性肝病合并高危冠状动脉斑块患者冠状动脉指标临床意义探讨^*[J]. 实用肝脏病杂志, 2022, 25(3): 383-386.

Cai Dongmei, Wu Wenjuan, Jiang Yilun, et al. Implication of hepatic fat fraction by CT angiography in patients with nonalcoholic fatty liver diseases and high-risk coronary plaque[J]. Journal of Practical Hepatology, 2022, 25(3): 383-386.

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CT检测非酒精性脂肪性肝病合并高危冠状动脉斑块患者冠状动脉指标临床意义探讨^*

Implication of hepatic fat fraction by CT angiography in patients with nonalcoholic fatty liver diseases and high-risk coronary plaque

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