咽、颈、胸痛与心脏反应新的临床综合征？  

Throat infection, neck spinal disease, chest pain and cardiac response： a new clinical syndrome ？

作　　者：周昌清[1] 严江涛[1] 范巧[1] 李卓娅[2] Katherine Cianflone 汪道文[1] 

机构地区：[1]华中科技大学同济医学院附属同济医院心内科,武汉430030 [2]华中科技大学同济医学院免疫教研室 [3]加拿大拉瓦尔大学附属拉瓦尔医院

出　　处：《中华心血管病杂志》2010年第2期147-151,共5页Chinese Journal of Cardiology

基　　金：国家自然科学基金项目（30571841,30770882）

摘　　要：目的探讨一个新临床综合征的识别，包括咽炎、颈椎病、胸痛和心脏反应。方法收集2003-2005年于本院治疗的同时具有咽炎、颈椎病、胸痛和心脏反应等症状并被排除冠心病的患者165例，并收集85例健康体检者作为对照组。检测研究对象血清抗β1肾上腺素能受体抗体，抗心肌肌球蛋白重链抗体，抗M2胆碱能受体抗体，抗心肌细胞线粒体内膜ADP／ATP载体蛋白抗体及炎症因子、高敏C反应蛋白，血清柯萨奇B病毒、巨细胞病毒、肺炎支原体和肺炎衣原体抗体，并用流式细胞仪测定淋巴细胞分类。结果所有的患者有四联症或五联症：（1）持续的咽部及上呼吸道感染；（2）颈痛；（3）胸痛；（4）胸闷及呼吸困难，有时伴有焦虑。病例组心肌自身抗体阳性率为100％，而健康对照组为8％。病例组的肿瘤坏死因子仪，白细胞介素1，白细胞介素6明显高于对照组（P〈0．01），病例组的总T淋巴细胞百分数和杀伤T淋巴细胞阳性百分数均明显高于对照组，而自然杀伤淋巴细胞明显低于对照组（P〈0．01）。病例组的血清柯萨奇B病毒、巨细胞病毒、肺炎支原体和肺炎衣原体抗体阳性率明显增高。结论证据表明存在一种与呼吸道感染相关的临床综合征，包括咽部感染、颈椎病、肋软骨炎、胸闷及呼吸困难，伴有（或无）焦虑症状。Objective To analyze the characteristics of a new clinical syndrome, including throat infection, neck spinal disease, chest pain and cardiac response. Methods A total of 165 patients with above mentioned symptoms admitted to Tongji hospital from 2003 to 2005 were included in this study and underwent further medical history inquiry, physical examination and laboratory tests. Eighty-five healthy subjects served as controls. Serum myocardial auto-antibodies against betal-adrenoceptor, alpha-myosin heavy chain, M2-muscarinic receptor and adenine-nucleotide translocator were detected, inflammatory cytokines, high sensitivity C-reaction protein, serum antibodies against Coxsackie virus-B, cytomegalovirus, Mycoplasma pneumoniae and Chlamydia pneumoniae were determined and lymphocyte subclasses were assayed by flow cytometry. Results All patients had a complex of four symptoms or tetralogy ： （ 1 ） persistent throat or upper respiratory tract infection; （2） neck pain; （3） chest pain; （4） chest depression or dyspnea, some of them with anxiety. Anti-myocardial auto-antibodies （AMCA） were present in all patients vs. 8% in controls. TNF-α, IL-1 and IL-6 were significantly higher in patients than controls （ P 〈 0. 01 ）. CD3 ^＋ and CD^ - CD8^＋ lymphocytes were significantly higher and CD56 ^＋ ]ymphocytes lower in patients than those in controls （ P 〈 0.01 ）. The ratios of serum pathogen antibodies positive against Coxsackie virus-B, cytomegalovirus, Mycoplasma pneumoniae and Ch｜amydia pneumoniae were all significantly higher in patients than in controls. Conclusions These data led to identification of a persistent respiratory infectionrelated clinical syndrome, including persistent throat infection, neck spinal lesion, rib cartilage inflammation, symptoms of cardiac depression and dyspnea with or without anxiety.

关 键 词：炎症 胸痛 心脏反应 诊断 

分 类 号：R54[医药卫生—心血管疾病]