1 徳島大学病院超音波センターUltrasound Examination Center, Tokushima University Hospital
2 徳島大学病院循環器内科Department of Cardiovascular Medicine, Tokushima University Hospital
目的：糖尿病患者は，冠動脈狭窄を有していても無症状な場合も多く，心電図や超音波検査で異常を指摘されなければ冠動脈精査に進まないことがある．我々は，超音波検査で計測した心外膜下脂肪（EAT）厚が冠動脈狭窄の有無と密接に関連していることを報告した．そこで本研究では，糖尿病患者のEAT厚が冠動脈狭窄の診断に有用か否かを検討することを目的とした．
対象と方法：当院で心臓カテーテル検査（CAG）を施行した糖尿病患者のうち，EAT厚を計測した182例（平均年齢67±11歳，男性128例）を対象とした．EAT厚は前室間溝の位置で収縮末期に計測した．CAGで有意狭窄（＞75%）を認めた108例を狭窄群，認めなかった74例を非狭窄群に分類した．
結果と考察：非狭窄群29例（39%），狭窄群61例（56%）で胸部症状を認めた．狭窄群のEAT厚は，非狭窄群に比べ有意に大であった（8.3±2.8 vs. 5.7±2.1 mm, p＜0.001）．ROC解析では，EAT厚＞7.0 mmをカットオフ値とすると感度67%，特異度78%で糖尿病患者の有意狭窄が診断できた．さらに，従来の冠危険因子に胸部症状の有無を加えてもArea under the carve（AUC）の増加は有意でなかったが，EAT厚を加えるとAUCは有意に増加した（AUC: 0.65 vs. 0.82, p＜0.001）．このことから，EAT厚は従来の冠危険因子や胸部症状に加えて冠動脈有意狭窄予測における付加的価値があることが示された．
結語：冠動脈狭窄を有する糖尿病患者のEAT厚は非狭窄患者に比べて有意に厚い．
Background: Although early detection of coronary artery disease (CAD) can reduce mortality, CAD in diabetic patients rarely presents typical symptoms and it is more difficult to detect. Recently, quantification of epicardial adipose tissue (EAT), which is thought to be an ectopic adipose tissue, has been developed as a means of detecting possible CAD. The purpose of this study was to investigate the relationship between EAT thickness measured by echocardiography and presence of CAD in patients with type 2 diabetes.
Subjects and Methods: We enrolled 182 patients with type 2 diabetes (mean age 67±11 yrs; 128 males, 54 females) who underwent coronary angiography between June 2011 and June 2016 at our hospital. We measured the EAT thickness in the anterior interventricular groove (EAT-AIG) by echocardiography using a high-frequency linear probe. Subjects were divided into two groups; with and without significant coronary stenosis (CAD group: 108 patients and non-CAD group: 74 patients) based on coronary angiography.
Results and Discussion: Forty-seven patients (44%) in the CAD group were asymptomatic. EAT-AIG thickness was significantly greater in the CAD group than of the non-CAD group (8.3±2.8 vs. 5.7±2.1 mm, p＜0.001). Through receiver operating characteristic analysis, EAT-AIG thickness had high c-statics (AUC: 0.82, p＜0.001) after adjustment for conventional risk factors (age, male gender, body mass index, hypertension, dyslipidemia, and smoking). EAT-AIG thickness had incremental diagnostic value over other conventional risk factors (AUC: 0.82 vs. 0.65, comparison p＜0.001) regardless of the presence of symptoms.
Conclusion: Echocardiographic EAT-AIG thickness was greater in the CAD group than in the non-CAD group. This non-invasive index may be a useful diagnostic marker for detecting CAD in patients with type 2 diabetes.
Key words: epicardial adipose tissue; diabetes; anterior interventricular groove coronary artery disease; high-frequency linear probe
© 2018 一般社団法人日本超音波検査学会© 2018 Japanese Society of Sonographers
This page was created on 2018-04-16T11:20:34.61+09:00
This page was last modified on 2018-06-01T17:10:46.880+09:00
このサイトは（株）国際文献社によって運用されています。
