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在人类房颤中的作用。左房(LA)心耳标本取自心血管手术期间房颤患者。组织学上，纤维性ATE重构的严重程度与LA心肌纤维化有关。在EAT中，LA心肌中的总胶原(即LA心肌纤维化)与促炎症和促纤维化的细胞因子/趋化因子呈正相关，包括IL-6、单核细胞趋化蛋白-1和肿瘤坏死因子-α。尸检获得人乳房周围脂肪组织和腹部皮下脂肪组织。使用有机培养系统将EAT或SAT衍生的条件培养液应用于大鼠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的促纤维化作用强于SAT。有房颤患者的EAT处理的有机培养的大鼠心房纤维化面积大于无房颤的患者。人重组血管生成素样蛋白2(Angptl2)诱导的大鼠心房纤维化可被抗Angptl2抗体抑制。最后，我们试图在计算机断层扫描(CT)图像上检测纤维化的EAT重构，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，用CT测定的EAT脂肪衰减的百分比变化可以无创性地检测EAT的重构。

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.