感染负荷与急性冠脉综合征的相关性研究  

Study on the correlation between infection burden and acute coronary syndrome

作　　者：刘大男[1] 何作云[2] 李金生[1] 刘兴德[1] 吴立荣[1] 方颖[1] 李屏[1] 

机构地区：[1]贵阳医学院附属医院心内科,550004 [2]解放军第三军医大学新桥医院心内科,重庆400037

出　　处：《中国急救医学》2008年第4期293-296,共4页Chinese Journal of Critical Care Medicine

基　　金：贵州省科学基金资助项目(黔科合字19991177号)

摘　　要：目的探讨感染负荷和急性冠脉综合征(ACS)的相关性。方法采用酶联免疫吸附法测定104例ACS患者和66例冠脉造影正常的健康者血清肺炎衣原体(Cpn)、幽门螺杆菌(Hp)、单纯疱疹病毒1型(HSV-1)、巨细胞病毒(CMV)、Hp细胞毒素相关蛋白(CagA-Hp)特异性抗体(IgG、IgM),用聚合酶链反应技术检测病原体DNA,并检测两组的炎症介质(sICAM-1、IL-6、hsCRP)。结果①ACS组Cpn、Hp、HSV-1、CMV病原体IgG阳性率和水平均高于正常对照组(均P<0.01),病原体DNA检测与抗体检测结果吻合。校正冠心病危险因素前后,各病原体IgG阳性均与ACS相关。②ACS组中各病原体感染患者sICAM-1、IL-6、hsCRP水平均高于非感染患者(均P<0.05),且4种病原体IgG均与sICAM-1、IL-6、hsCRP呈正相关。③ACS组中3种以上病原体IgG阳性患者的比例显著高于正常对照组,3、4种病原体IgG阳性患者ACS发生率及其炎症介质水平显著高于1、2种病原体IgG阳性患者(P均<0.05)。结论Cpn、Hp、HSV-1、CMV感染与ACS、炎症反应独立相关,不同毒力的Hp感染与ACS无关,感染负荷可增强炎症反应,增加ACS的危险。Objective To investigate the correlations of infection burden with acute coronary syndrome （ACS）. Methods Specific chlamydia pneumoniae （ Cpn ） , helicobacter pylori （ Hp ） , herpes simplex virus type 1 （ HSV - 1 ） , and cytomegalovirus （ CMV ） , inflammation and helicobacter pylori cytotoxin associated protein - A （ CagA - Hp ） antibodies （ IgG, IgM ） and the DNAs of Cpn, HSV - 1 and CMV were measured in 104 patients with ACS（ ACS group） and 66 normal controls （NC group） who had no angiographic evidence of coronary artery disease. Moreover, the changes of inflammation mediators （ sICAM - 1, IL - 6, hsCRP） were determined in two groups. Results （1） The prevalence of Cpn IgG, Hp IgG and HSV - 1 IgG was associated with ACS. The positive rates and levels of CpnIgG, HpIgG, HSV - 11gG and CMVIgG in ACS group were significantly higher than those in NC group（ P 〈 0. 01 ）. （2）Those whose pathogen IgG was positive in the ACS group had significantly higher levels of inflammation mediators than those whose pathogen IgG was negative in the same group. Correlation analysis revealed that the average concentration of IgG antibodies to Cpn, Hp, HSV - 1 and CMV was positively associated with the levels of sICAM - 1, IL - 6, hsCRP in those patients. （3）Those whose IgG antibodies to 3 or 4 pathogens were positive in the ACS group had significantly higher proportion and inflammation mediators levels than those in the NC group and than those whose IgG antibodies to 1 or 2 pathogens were positive in the same group. Conclusion There are significant correlations of Cpn, Hp, HSV - 1 and CMV infection with the inflammation and ACS. The association between the virulence of Hp and ACS was not significant. Infection burden may increase inflammatory response so the risk of ACS is higher.

关 键 词：急性冠脉综合征 感染负荷 肺炎衣原体 幽门螺杆菌 单纯疱疹病毒 巨细胞病毒 

分 类 号：R541.4[医药卫生—心血管疾病]