病原微生物负荷及炎症因子与颈动脉粥样硬化斑块稳定性的相关性研究  

Correlation study of pathogen burden and inflammatory factors with stability of carotid atherosclerotic plaque

作　　者：吴鉴今 黄通 沈旭 何天啸 曲乐丰 WU Jianjin;HUANG Tong;SHEN Xu;HE Tianxiao;QU Lefeng(Department of Vascular Surgery,Second Affiliated Hospital of Naval Medical University,Shanghai 200003,China)

机构地区：[1]海军军医大学第二附属医院血管外科,上海200003

出　　处：《上海医学》2022年第10期692-698,共7页Shanghai Medical Journal

基　　金：国家自然科学基金(81870347);上海市卫生健康委员会老龄化和妇儿健康研究专项基金(2020YJZX0125);海军军医大学第二附属医院创新型临床研究重点项目(2020YLCYJ-Z09);海军军医大学“三航”军事医学人才项目(2019-Q11-25)。

摘　　要：目的探讨病原微生物负荷(PB)及炎症因子与颈动脉粥样硬化斑块(CAP)稳定性的相关性。方法回顾性分析2013年4月—2015年3月海军军医大学第二附属医院血管外科门诊收治的经颈动脉血管超声明确诊断为CAP,并收录于CAP临床生物样本库的232例患者资料。观察并记录患者年龄、性别、BMI、基础疾病、吸烟史、LDL-C、TC、TG、高密度脂蛋白(HDL)等一般资料,检测血清学病原微生物抗体[EB病毒抗体(EBV IgG)、单纯疱疹病毒1抗体(HSV1 IgG)、单纯疱疹病毒2抗体(HSV2 IgG)、巨细胞病毒抗体(CMV IgG)、幽门螺杆菌抗体(H.pylori IgG)、肺炎衣原体抗体(CPN IgG)]和超敏C反应蛋白(hs-CRP)、人类软骨糖蛋白-39(YKL-40)等炎症因子水平,计算PB值。依据颈动脉狭窄程度将患者分为轻度狭窄组(89例)、中度狭窄组(71例)和重度狭窄组(72例),并进一步分为血清学稳定斑块组(128例)和不稳定斑块组(104例);同时,对接受颈动脉内膜斑块切除术的58例患者,按照超声检查和术后病理切片进行斑块稳定性分类,分为组织学不稳定斑块组(21例)和稳定斑块组(37例)。分析患者血清学PB及炎症因子与狭窄程度和斑块稳定性的相关性,以及组织学病原微生物抗体和炎症因子与斑块稳定性的相关性。结果中度和重度狭窄组的TC水平均较轻度狭窄组显著增高(P值均<0.001);重度狭窄组的TG水平较轻度狭窄组和中度狭窄组显著增高(P=0.001、0.004);重度狭窄组的HDL水平较中度狭窄组显著降低(P<0.05)。3组间血清学炎症因子水平、各病原微生物抗体的阳性率和PB值的差异均无统计学意义(P值均>0.05)。血清学不稳定斑块组HSV1 IgG阳性率、H.pylori IgG阳性率、CPN IgG阳性率、PB值及YKL-40水平均显著高于稳定斑块组(P值均<0.01),两组间hs-CRP水平的差异无统计学意义(P>0.05)。以CAP稳定性作为因变量进行的二元有序logistic回归分析结果示,不稳定斑块组YKL-Objective To explore the correlation between pathogen burden(PB)and inflammatory factors and carotid atherosclerotic plaque(CAP)stability.Methods Clinical data of 232 CAP patients admitted to our center from April 2013 to March 2015 were retrospectively analyzed.General information such as age,gender,body mass index(BMI),underlying diseases,smoking history,low-density lipoprotein cholesterol(LDL-C),total cholesterol(TC),triglyceride(TG),high-density lipoprotein(HDL),serological pathogenic microorganism antibodies including Epstein-Barr virus antibody(EBV IgG),herpes simplex virus 1 antibody(HSV1 IgG),herpes simplex virus 2 antibody(HSV2 IgG),cytomegalovirus antibody(CMV IgG),Helicobacter pylori antibody(H.pylori IgG),Chlamydia pneumoniae antibody(CPN IgG),and the levels of inflammatory factors such as high-sensitivity C-reactive protein(hs-CRP)and YKL-40 were collected.PB was calculated.According to the degree of carotid artery stenosis,the patients were divided into mild stenosis group(n=89),moderate stenosis group(n=71)and severe stenosis group(n=72).They were further divided into serologically stable plaque group(n=128)and unstable plaque group(n=104).According to the plaque stability determined by ultrasonography and postoperative pathological sections,58 patients who underwent carotid endarterectomy were assigned to histologically unstable plaque group(n=21)and stable group(n=37).The correlation between serological PB and inflammatory factors and the degree of stenosis and plaque stability,as well as the correlation between histological pathogenic microorganism antibodies and inflammatory factors and plaque stability were analyzed.Results The TC of the moderate and severe stenosis groups was significantly higher than that of the mild stenosis group(P<0.001).The TG of the severe stenosis group was significantly higher than that of the mild and moderate stenosis groups(P=0.001,0.004).The HDL of the severe stenosis group was significantly lower than that of the moderate stenosis group(P<0.05).There were no sign

关 键 词：病原微生物负荷 炎症 颈动脉粥样硬化斑块 斑块稳定性 人类软骨糖蛋白-39 

分 类 号：R743.3[医药卫生—神经病学与精神病学]