Chinese General Practice ›› 2022, Vol. 25 ›› Issue (06): 643-650.DOI: 10.12114/j.issn.1007-9572.2021.02.116
Special Issue: 述评栏目最新文章合集; 肥胖最新文章合集
• Editorial • Next Articles
Actively Managing Obesity to Reduce the Risk of Cardiovascular Disease
Department of Cardiovascular Medicine,Nanfang Hospital,Southern Medical University,Guangzhou 510515,China
*Corresponding author:ZENG Qingchun,Professor,Doctoral supervisor;E-mail:qingchunzeng@smu.edu.cn
Received:
2021-08-24
Revised:
2021-10-26
Published:
2022-02-20
Online:
2022-01-25
通讯作者:
曾庆春
基金资助:
CLC Number:
GUO Yuyang, ZENG Qingchun.
Actively Managing Obesity to Reduce the Risk of Cardiovascular Disease [J]. Chinese General Practice, 2022, 25(06): 643-650.
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URL: https://www.chinagp.net/EN/10.12114/j.issn.1007-9572.2021.02.116
诊断方式 | 优点 | 缺点 | 注意事项 | |
---|---|---|---|---|
非侵入性检查 | ||||
心电图 | 便捷,便宜 | 灵敏度、特异度低,受肥胖影响 | 肥胖可导致心率增快、QRS间期延长、QT间期延长、假阳性的下壁心肌梗死等心电图改变 | |
平板运动试验 | 便捷 | 患者可能会因为与心血管疾病无关的症状而停止 | 肥胖患者的峰值心率、心率恢复和变时指数均较低 | |
SPECT | 精度高 | 有辐射,技术上对体型有限制,肥胖患者常见乳房和膈肌的衰减伪影,相对灌注显像对三支病变或左主干病变的检测能力降低 | 对于体质量较大的患者〔250~350磅(113~160 kg)〕,建议采用为期2 d、剂量较大的示踪剂方案,体质量上限约为350磅(160 kg) | |
PET(铷) | 较SPECT成像效果更好,辐射更小,伪影和衰减少;可绝对定量冠状动脉血流,适用于三支病变及左主干病变 | 对体型有限制 | - | |
负荷超声心动图 | 便捷,适用于肥胖患者,无辐射,无体质量/体型限制,功能性测试 | 对操作者要求高,受肺部疾病、乳房大小、肥胖、呼吸运动影响 | - | |
负荷心脏MRI | 可准确评估慢性压力负荷和心排血量高的复杂心脏效应,肥胖对此项检查影响小 | 对体质量、体型等有限制,幽闭恐怖症患者不适用 | MRI台的重量限制为335磅(152 kg) | |
心脏CT钙扫描 | 经济、重复性好,可测定冠状动脉疾病程度 | 肥胖可能限制心脏CT钙扫描的诊断准确性和价值,仪器内径对体型有限制 | CT设备的台面重量限制为350~450磅(160~204 kg) | |
冠状动脉CT增强扫描 | 检测肥胖患者的灵敏度和阴性预测值较高 | 图像质量、信噪比随BMI的增加而下降,肥胖患者血管不可评估段的比例更高 | - | |
侵入性检查 | ||||
冠状动脉造影 | 冠状动脉疾病诊断的金标准 | 肥胖患者血管通路不畅,并发症更多,为达到足够的透视度,肥胖患者和术者需要接受更高的辐射 | 肥胖患者首选桡动脉通路,桡动脉入路的并发症发生率比股动脉入路低3倍[ | |
血管内超声 | 可对斑块负荷、斑块形态(即斑块发展阶段、高风险斑块特征)进行体内评估 | 侵入性操作 | - |
Table 1 Considerations for use of noninvasive and invasive diagnostic tools for coronary artery disease in patients with obesity
诊断方式 | 优点 | 缺点 | 注意事项 | |
---|---|---|---|---|
非侵入性检查 | ||||
心电图 | 便捷,便宜 | 灵敏度、特异度低,受肥胖影响 | 肥胖可导致心率增快、QRS间期延长、QT间期延长、假阳性的下壁心肌梗死等心电图改变 | |
平板运动试验 | 便捷 | 患者可能会因为与心血管疾病无关的症状而停止 | 肥胖患者的峰值心率、心率恢复和变时指数均较低 | |
SPECT | 精度高 | 有辐射,技术上对体型有限制,肥胖患者常见乳房和膈肌的衰减伪影,相对灌注显像对三支病变或左主干病变的检测能力降低 | 对于体质量较大的患者〔250~350磅(113~160 kg)〕,建议采用为期2 d、剂量较大的示踪剂方案,体质量上限约为350磅(160 kg) | |
PET(铷) | 较SPECT成像效果更好,辐射更小,伪影和衰减少;可绝对定量冠状动脉血流,适用于三支病变及左主干病变 | 对体型有限制 | - | |
负荷超声心动图 | 便捷,适用于肥胖患者,无辐射,无体质量/体型限制,功能性测试 | 对操作者要求高,受肺部疾病、乳房大小、肥胖、呼吸运动影响 | - | |
负荷心脏MRI | 可准确评估慢性压力负荷和心排血量高的复杂心脏效应,肥胖对此项检查影响小 | 对体质量、体型等有限制,幽闭恐怖症患者不适用 | MRI台的重量限制为335磅(152 kg) | |
心脏CT钙扫描 | 经济、重复性好,可测定冠状动脉疾病程度 | 肥胖可能限制心脏CT钙扫描的诊断准确性和价值,仪器内径对体型有限制 | CT设备的台面重量限制为350~450磅(160~204 kg) | |
冠状动脉CT增强扫描 | 检测肥胖患者的灵敏度和阴性预测值较高 | 图像质量、信噪比随BMI的增加而下降,肥胖患者血管不可评估段的比例更高 | - | |
侵入性检查 | ||||
冠状动脉造影 | 冠状动脉疾病诊断的金标准 | 肥胖患者血管通路不畅,并发症更多,为达到足够的透视度,肥胖患者和术者需要接受更高的辐射 | 肥胖患者首选桡动脉通路,桡动脉入路的并发症发生率比股动脉入路低3倍[ | |
血管内超声 | 可对斑块负荷、斑块形态(即斑块发展阶段、高风险斑块特征)进行体内评估 | 侵入性操作 | - |
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