心外膜脂肪の線維化を検出し心房細動ハイリスク患者を同定するCT画像診断法

我们之前研究了EAT在人类AF中的作用。在心血管手术期间从AF患者获得左心耳（LA）样本。在组织学上，EAT重构的严重程度与LA心肌纤维化相关。LA心肌中的总胶原蛋白（即，LA心肌纤维化）与EAT中促炎和促纤维化细胞因子/趋化因子（包括白细胞介素-6、单核细胞趋化蛋白-1和肿瘤坏死因子-α）呈正相关。通过尸检获得人LA周围EAT和腹部皮下脂肪组织（SAT）。使用有机培养系统将EAT或SAT衍生的条件培养基应用于大鼠LA心外膜表面。EAT条件培养液诱导器官培养大鼠心房纤维化。EAT的促纤维化作用大于SAT。用来自AF患者的EAT治疗的器官培养的大鼠心房的纤维化面积大于无AF的患者。用人重组血管生成素样蛋白2（Angptl 2）治疗诱导器官培养的大鼠心房的纤维化，其通过用抗Angptl 2抗体伴随治疗而被抑制。最后，我们尝试在计算机断层扫描（CT）图像上检测纤维化EAT重塑，这表明EAT脂肪衰减的百分比变化与EAT纤维化呈正相关。基于这些发现，我们得出结论，使用CT非侵入性检测EAT脂肪衰减的百分比变化检测EAT重塑。

We previously investigated the role of EAT in AF in humans. Left atrial (LA) appendage samples were obtained from AF patients during cardiovascular surgery. Histologically, the severity of fibrotic EAT remodeling was associated with LA myocardial fibrosis. Total collagen in the LA myocardium (i.e., LA myocardial fibrosis) was positively correlated with proinflammatory and profibrotic cytokines/chemokines, including interleukin-6, monocyte chemoattractant protein-1, and tumor necrosis factor-α, in EAT. Human peri-LA EAT and abdominal subcutaneous adipose tissue (SAT) were obtained by autopsy. EAT- or SAT-derived conditioned medium was applied to the rat LA epicardial surface using an organo-culture system. EAT-conditioned medium induced atrial fibrosis in organo-cultured rat atrium. The profibrotic effect of EAT was greater than that of SAT. The fibrotic area of the organo-cultured rat atrium treated with EAT from patients with AF was greater than in patients without AF. Treatment with human recombinant angiopoietin-like protein 2 (Angptl2) induced fibrosis in organo-cultured rat atrium, which was suppressed by concomitant treatment with anti-Angptl2 antibody. Finally, we attempted to detect fibrotic EAT remodeling on computed tomography (CT) images, which demonstrated that the percent change in EAT fat attenuation was positively correlated with EAT fibrosis. Based on these findings, we conclude that the percent change in EAT fat attenuation determined using CT non-invasively detects EAT remodeling.