The Relationship Between Epicardial Adipose Tissue and Insulin Resistance in Obese Children

Abstract Background Insulin resistance (IR) is an important disorder in obese children because it is closely related to cardiovascular diseases. Epicardial adipose tissue (EAT) plays a role in the development of IR due to secreted bioactive molecules, and the inflammatory process of these molecules may cause atrial electromechanical delay (EMD). Objective The objective of our study was to determine the relationship between EAT and EMD with IR in obese children. Methods Ninety-four obese patients were included in the study. IR was calculated using the Homeostatic Model Assessment for Insulin Resistance (HOMA-IR) and defined as HOMA-IR greater than the 90thpercentile in an age- and sex-specific percentile curve. Patients were divided into two groups according to their IR. All patients underwent echocardiographic examinations. Statistical significance was set to a two-sided p-value < 0.05. Results EAT was significantly higher in the IR group (p < 0.001). The optimal cut-off value for EAT to predict IR was found to be > 3.85 mm, with 92.5% specificity and 68.5% sensitivity (p = 0.002). In the multivariate logistic regression model, EAT (OR = 1.256, 95% CI: 1.016–1.53, p = 0.035) was also associated with IR after adjustment for variables found to be statistically significant in univariate analysis. Inter- and intra-atrial EMD was significantly prolonged in the IR group compared to the group without IR (p < 0.010; p = 0.032 respectively). Conclusion: In our study, we revealed that EAT was positively correlated with IR and was an independent predictor of IR. (Arq Bras Cardiol. 2020; [online].ahead print, PP.0-0)

【摘要 背景】胰岛素抵抗（Insulin resistance, IR）是肥胖儿童的重要代谢紊乱，因其与心血管疾病密切相关。心外膜脂肪组织（Epicardial adipose tissue, EAT）可通过分泌生物活性分子参与胰岛素抵抗的发生发展，此类分子介导的炎症过程可能引发心房电机械延迟（atrial electromechanical delay, EMD）。【研究目的】本研究旨在明确肥胖儿童心外膜脂肪组织、心房电机械延迟与胰岛素抵抗之间的关联。【研究方法】本研究纳入94名肥胖患者。采用稳态模型评估法（Homeostatic Model Assessment for Insulin Resistance, HOMA-IR）计算胰岛素抵抗水平，以年龄和性别特异性百分位曲线中第90百分位以上作为胰岛素抵抗的判定标准。根据胰岛素抵抗状态将患者分为两组。所有受试者均接受超声心动图检查。统计学检验采用双侧检验，以p<0.05为差异具有统计学意义。【研究结果】胰岛素抵抗组患者的心外膜脂肪组织厚度显著高于非胰岛素抵抗组（p<0.001）。心外膜脂肪组织预测胰岛素抵抗的最佳截断值为>3.85mm，对应特异性92.5%、敏感性68.5%（p=0.002）。多因素logistic回归分析显示，在校正单因素分析中具有统计学意义的变量后，心外膜脂肪组织（OR=1.256，95%CI：1.016~1.53，p=0.035）仍与胰岛素抵抗独立相关。与非胰岛素抵抗组相比，胰岛素抵抗组患者的心房间及心房内电机械延迟均显著延长（分别为p<0.010；p=0.032）。【研究结论】本研究表明，肥胖儿童的心外膜脂肪组织与胰岛素抵抗呈正相关，且可作为胰岛素抵抗的独立预测因子。（《巴西心脏病学杂志》2020年；[在线预印版]，页码0-0）