血管周围脂肪组织在动脉粥样硬化中的研究进展

Research Progress of Perivascular Adipose Tissue in Atherosclerosis

摘要: 血管周围脂肪组织(PVAT)包围大部分脉管系统，可以调节血管稳态并且影响动脉粥样硬化的过程。最近的研究表明，在血管壁及其PVAT之间存在双向信号通路，这在心血管诊断和治疗中具有深远的意义。血管炎症在动脉粥样硬化进展和斑块破裂中其主要作用，冠状动脉CT血管造影(CCTA)通过分析冠脉周围脂肪组织(PCAT)密度的变化随之提出一种可以检测冠状动脉炎症的生物标记物——血管周围脂肪衰减指数(FAI)，由于冠状动脉硬化还与不良纤维化和血管重构有关，通过分析PCAT细微的组织结构变化提出了放射组学特征，其有望最大化CCTA的诊断和预后效果。在本综述中，我们首先阐述了脂肪组织、炎症及动脉粥样硬化之间的关系，随后我们描述了血管周围脂肪组织和心血管系统之间相互作用的双向作用，介绍了基于CCTA的影像学成像用于心血管风险分层的进展。

Abstract: Perivascular adipose tissue (PVAT) surrounds most of the vasculature and can regulate vascular homeostasis and influence the process of atherosclerosis. Recent studies have shown that there is a bidirectional signaling pathway between blood vessel walls and their PVAT, which has profound implications in cardiovascular diagnosis and therapy. Vascular inflammation plays a major role in the progression of atherosclerosis and plaque rupture. Coronary CT angiography (CCTA) proposes a biomarker that can detect coronary inflammation, the perivascular fat attenuation index (FAI), by analyzing the changes in the density of pericoronary adipose tissue (PCAT). Since coronary arterio-sclerosis is also associated with adverse fibrosis and vascular remodeling, radiomic features are proposed by analyzing subtle structural changes in PCAT, which are expected to maximize the di-agnostic and prognostic effects of CCTA. In this review, we first describe the relationship between adipose tissue, inflammation, and atherosclerosis, then we describe the bidirectional interaction between perivascular adipose tissue and the cardiovascular system, and we present advances in CCTA-based imaging for cardiovascular risk stratification.