The Research Of The Relationship Between Serum Vitamin D And Epicardial Adipose Tissue Thickness,the Extent Of Coronary Artery Lesion In CHD Patients,and The Myocardial Reperfusion Level In STEMI Patients

Aim:Epicardial adipose tissue is the fat tissue between pericardium and myocardial surface and contacts coronary arteries directly.Epicardial adipose tissue(EAT)has metabolic activity,clinical research shows that epicardial adipose tissue thickness(EATT)has significant correlation with the extent of coronary artery disease.Scholars regard that vitamin D deficiency can promote inflammatory factors and chemokines in EATTthen involve in the development of atherosclerosis,but studies of the relationship between serum vitamin D level and EATT in CAD patients is relatively rare.As to the STEMI patients,primary percutaneous coronary intervention is one of the most important therapies.But opening the culprit artery does not improve the myocardial perfusion in some patients.A lot of studies suggest that myocardial perfusion disturbance is a predictor of ventricle remodeling,severe arrhythmiaand heart failure and can cause higher hospital mortality long term morbidity.Apart from taking part in calcium-phosphorus metabolism,vitamin D plays an important role in maintaining the physiological function of cardiovascular system.Vitamin D can protect endothelial cell function and can also inhibit inflammatory reaction,which may reduce ischemia reperfusion injury.Since studies of vitamin D and ischemia reperfusion dysfunction is relatively rare,our research aims to explore the relationship between serum vitamin D and epicardial adipose tissue thickness,the extent of coronary artery lesion in CAD patients and the myocardial reperfusion level in STEMI patients.Methods: 1)The study of the relationship between serum vitamin D level and epicardial adipose tissue thickness and the extent of coronary artery lesion in CAD patients.A total of 510 patients whose admitting diagnosis was CAD were enrolled from April 2016 to April 2017 in our center.All participants underwent coronary arteriography and multilayer spiral cardiac CT scan subsequently.Gensini scores were calculated according to the results of coronary arteriography,and EATT in the areas of left anterior descending artery,left circumflex coronary artery,and right coronaryartery were measured based on CT image.Age,blood pressure,height,weight,smoking history and past medical history were recorded and serum 25-(OH)D,glycosylated hemoglobin,serum creatinine,TC,TG,HDL,LDL were measured in the meantime.The relationship between serum vitamin D and epicardial adipose tissue thickness and the extent of coronary artery lesion was analyzed.2)The study of the relationship between serum vitamin D level and the myocardial reperfusion level in STEMI patients.A total of 164 patients whose admitting diagnosis was STEMI were enrolled from March 2016 to February 2018 in our center.All participants underwent coronary arteriography and primary percutaneous coronary intervention.TMPFC were calculated according to the images of coronary arteriography after opening the culprit artery,and chest-pain duration,age,systolic blood pressure,diastolic blood pressure,height,weight,smoking history and past medical history were recorded.Serum 25-(OH)D,white blood cell count,red blood cell count,blood platelet count,fasting blood glucose,glycosylated hemoglobin,serum creatinine,TC,TG,HDL,LDL,other blood indexand left ventricular ejection fraction were measured in the meantime.The affecting factors of TMPFC and relationship between serum vitamin D and TMPFC were analyzed.Results:1)All participants were divided into CAD group and the control group according to the results of coronary angiography.The difference of age,gender,hypertension history,diabetes history and smoking history was significant between two groups(P<0.05).There was no significant difference of family history of CAD,hyperlipemia,BMI,systolic blood pressure and diastolic blood pressure.The level of25-(OH)D,HDL,glycosylated hemoglobin,serum creatinine and EATT was significantly different between two groups(P< 0.05).There was no significant difference of the level of TC,TG and LDL between two groups.The mean serum25-(OH)D level of CAD group(15.7±5.9ng/ml)was significantly lower than that in control group(16.9±5.6ng/ml)(P= 0.027).Mean EATT of CAD group(8.8±2.6mm)was significantly higher than that in control group(7.6±2.1mm)(P<0.001).Serum25-(OH)D level was negatively correlated with mEATT(r=-0.573,P < 0.001)and Gensini score(r=-0.019,P=0.001).Multivariate regression analysis showedthat25-(OH)D level was an independent predictor of mEATT(?=-0.229,P<0.001)and Gensini score(?=-0.770,P<0.001).2)235 patients were divided in tertile according to TMPFC.The age,gender,history of diabetes,history of hypertension,history of smoking,family history of coronary artery disease,chest-pain duration,hyperlipidemia,thrombolysis before PCI,systolic blood pressure,diastolic blood pressure and BMI were no difference among 3groups(P>0.05).The TG,HDL,LDL,WBC count,RBC count,Platelet count,BUN,creatinine,UA,fasting blood-glucose level,glycosylated hemoglobin,peak value of high sensitive CRP,peak value of BNP,peak value of TNI,peak value of CK-MB and left ventricular ejection fractionwere no difference among 3 groups(P>0.05).TC level and serum 25-(OH)D level were significantly different among 3 groups(P=0.049 and 0.001).The level of serum 25-(OH)D concentration was 16.96±6.62ng/ml?13.47± 5.65ng/ml and 12.84 ± 5.64ng/ml from the lowest tertile to the highest tertile respectively.Serum 25-(OH)D level was negatively correlated with TMPFC in STEMI patients(r=-0.227,P=0.004).Multivariate regression analysis showed that25-(OH)D level was an independent predictor of TMPFC(?=-0.628,P=0.008).Conclusion: 1)The level of serum vitamin D is significantly lower in CAD group than that in the control group.There is significantly negative correlation between serum vitamin D level and epicardial adipose tissue thickness and the severity of coronary artery disease.Multivariate regression analysis showed that25-(OH)D level was an independent predictor of mEATTand Gensini score.2)There is significantly negative correlation between serum vitamin D concentration and TMPFC.Multivariate regression analysisshowed that 25-(OH)D level was an independent predictor of TMPFC.