冠周脂肪组织的生物学意义及其成像技术
The Biological Significance of Pericoronary Adipose Tissue and Its Imaging Techniques
摘要: 冠状动脉粥样硬化是冠状动脉粥样硬化性心脏病的核心病理基础，其发生发展是“由内向外”与“由外向内”双重机制共同作用的结果。冠周脂肪组织(PCAT)作为心外膜脂肪的重要组成部分，直接包绕冠状动脉且无筋膜屏障分隔，具有显著的旁分泌与血管分泌功能，在维持血管稳态和参与冠脉炎症反应中发挥关键作用。病理状态下，PCAT发生表型转化，由保护性组织转变为促炎性组织，通过双向互作机制参与动脉粥样硬化进展及易损斑块形成。非侵入性成像技术为PCAT的临床评估提供了重要手段，本文系统综述了PCAT的解剖学与生理学基础、其在动脉粥样硬化中的作用机制，重点阐述了正电子发射断层显像/计算机断层扫描(PET/CT)、超声心动图、心脏磁共振(CMR)、血管内成像及冠状动脉计算机断层扫描血管造影(CCTA)等技术在PCAT评估中的应用进展、优势与局限性，最后对PCAT成像技术的未来研究方向进行展望，为冠状动脉疾病的风险分层、早期诊断及治疗评估提供理论参考与临床依据。
Abstract: Coronary atherosclerosis is the core pathological basis of coronary atherosclerotic heart disease, and its occurrence and development are the result of the dual mechanisms of “from inside to outside” and “from outside to inside”. Pericoronary Adipose Tissue (PCAT), as an important component of epicardial fat, directly surrounds the coronary arteries without a fascial barrier, and has significant paracrine and vascular secretory functions, playing a key role in maintaining vascular homeostasis and participating in coronary inflammatory responses. Under pathological conditions, PCAT undergoes phenotypic transformation, changing from a protective tissue to a pro-inflammatory one, and participates in the progression of atherosclerosis and the formation of vulnerable plaques through a bidirectional interaction mechanism. Non-invasive imaging techniques provide important means for the clinical assessment of PCAT. This article systematically reviews the anatomical and physiological basis of PCAT and its mechanism of action in atherosclerosis, with a focus on the application progress, advantages and limitations of Positron Emission Tomography/Computed Tomography (PET/CT), echocardiography, Cardiac Magnetic Resonance (CMR), intravascular imaging and Coronary Computed Tomography Angiography (CCTA) in the assessment of PCAT. Finally, it looks forward to the future research directions of PCAT imaging technology, providing theoretical references and clinical evidence for the risk stratification, early diagnosis and treatment evaluation of coronary artery disease.
文章引用：刘慧, 张英, 刘庆. 冠周脂肪组织的生物学意义及其成像技术[J]. 临床医学进展, 2026, 16(6): 671-682. https://doi.org/10.12677/acm.2026.1662265

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