以冠狀動脈電腦斷層血管攝影量化研究探討循環中的脂質和左心房體積之相關性

Evaluation of The Associations Between Circulatory Lipids and Left Atrial Volume by Quantification Study Using Images of Computed Tomography Coronary Angiography

趙敏芳(Min-Fang Chao)

指導教授 ： 許瑞昇

高雄醫學大學/醫學院/臨床醫學研究所碩士班/碩士(2019年)

摘要

代謝症候群會造成左心房幾何結構的擴張，進而造成心律不整、7影響心臟功能和惡化心衰竭。在代謝症候2群的影響因子中，脂質異常扮演相當重要角色。然而代謝因子和脂質對左心房幾何結構和重塑的早期影響尚未有研究報告。因此，本篇欲藉由冠狀動脈電腦斷層血管攝影的影像，來探討代謝因子和脂質對於左心房體積結構的相關性。回溯分析103位沒有心血管疾病和臨床症狀並接受冠狀動脈電腦斷層血管攝影健康檢查的個案，利用簡單和多重線性回歸方法，分析操作變相:如年齡、性別、肥胖（身體質量指數＞31）、血壓、血糖、高密度膽固醇、低密度膽固醇和三酸甘油酯分別對於心臟的早期排空和末期舒張的體積和指數的相關性。在個別探討因子，年齡(B-estimate= 0.67, P= 0.001)的增加、高密度膽固醇(0.71, P= 0.024)的上升會造左心房舒張末體積指數上升；而三酸甘油酯(-0.11, P= 0.001)的上升，會造成左心房舒張末期體積指數下降。而在調整其他因子後，年齡(B-estimate= 0.43, P= 0.039)維持對於左心房舒張末體積指數有正相關；而三酸甘油酯(-0.07, P= 0.032)則呈現負相關。此測量心臟體積的方法有良好觀察者的信度和效度。在初期代謝症候群個案其生理組織呈現飢餓狀態，在此狀況下，三酸甘油酯在血液中的濃度和左心房的舒張末期體積指數呈現負相關。因此，在早期代謝症候群，三酸甘油也會影響左心房重塑，其致病機轉仍有待更進一步研究。

關鍵字

三酸甘油酯 ； 代謝症候群 ； 脂質 ； 左心房體積 ； 電腦斷層攝影 ； 逆相關

並列摘要

Background: Left atrial enlargement is strongly correlated with metabolic syndrome, in which dyslipidemia intervenes the core pathophysiology. By using of coronary computed tomography (CT) angiography images, the correlation of left atrial volume with metabolic factors and lipid profiles was evaluated.
Material and methods: Total 103 individuals who received a standard coronary CT angiography examination but without overt cardiovascular diseases, were retrospectively enrolled and divided into groups with and without metabolic syndrome. Observational variables included age, gender, obesity (body mass index> 30), diabetes mellitus, hypertension, cholesterol, triglyceride, low density lipoprotein-cholesterol (LDL-C), high density lipoprotein-cholesterol (HDL-C), and non-HDL-C. On CT images, left atrial early empty volume (EEV), end-diastolic volume (EDV), and end-diastolic volume index (EDVi) were measured. The correlations of the left atrial volumes with above variables were assessed by univariate and multi-variable analyses.
Results: The agreements of the inter-observer and intra-observer in the left atrial volume were excellent. In univariate analysis, age (B-estimate= 0.67, P= 0.001), HDL-C (0.71, P= 0.024), and triglyceride (-0.11, P= 0.001) were significantly correlated with left atrial EDVi. In adjusted multivariable model with stepwise method, triglyceride (-0.07, P= 0.032) and age (0.43, P= 0.039) remained significant correlation with left atrial EDVi.
Conclusions: Triglyceride level at fasting status was inversely correlated with CT-quantified left atrial end-diastolic volume index. The metabolism of triglyceride might play a key role on atrial remodeling for individuals with metabolic syndrome.

並列關鍵字

triglyceride ； circulatory lipids ； lipid profile ； metabolic syndrome ； left atrial volume ； computed tomography ； coronary angiography ； inverse association

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