Whincup P, Danesh J, Walker M, Lennon L, Thomson A, Appleby P, Hawkey C, Atherton J
Department of Population Sciences and Primary Care, Royal Free UCL Medical School, London, UK.
Circulation. 2000 Apr 11;101(14):1647-52. doi: 10.1161/01.cir.101.14.1647.
Studies are needed to test claims that potentially virulent strains of Helicobacter pylori are more strongly related to coronary heart disease (CHD) than are other strains.
We measured serum IgG antibodies to mixed H pylori antigens and separately to the virulence-associated H pylori antigen CagA (cytotoxin-associated gene product A) in 505 CHD cases and in 1025 age-matched controls "nested" in a prospective study of 7735 British men (mean duration of follow-up in controls, 16 years). Of the 505 cases, 401 (79%) were seropositive for H pylori antibodies compared with 740 (72%) of the 1025 controls, yielding an odds ratio for CHD of 1.55 (95% CI 1.19 to 2.03), which fell to 1.30 (95% CI 0.88 to 1. 90) after adjustments were made for standard vascular risk factors and indicators of socioeconomic status. Of the CHD cases, 240 (48%) were seropositive for IgG antibodies to CagA compared with 450 (44%) of the controls. When CagA-seropositive individuals were compared with H pylori-seronegative individuals, the odds ratio for CHD was 1. 42 (95% CI 1.06 to 1.91), which fell to 1.10 (95% CI 0.71 to 1.71) after adjustments. In an analysis restricted to the 1141 (75%) H pylori-seropositive participants, the odds ratio for CHD was 1.0 (95% CI 0.78 to 1.29) in CagA-seropositive men. No strong associations were observed between H pylori seropositivity and blood lipids, blood pressure, markers of systemic inflammation, or plasma homocysteine.
H pylori infection is not strongly related to the incidence of CHD in late middle-aged men, and CagA-positive strains appear to be no more strongly related to the disease than other strains. However, further studies are required to confirm or refute the existence of any moderate associations, particularly at younger ages.
需要开展研究来验证关于幽门螺杆菌潜在致病菌株比其他菌株与冠心病（CHD）关联更强的说法。
我们在505例冠心病患者以及在一项对7735名英国男性进行的前瞻性研究中“嵌套”的1025名年龄匹配的对照者（对照者的平均随访时间为16年）中，检测了针对幽门螺杆菌混合抗原以及分别针对与毒力相关的幽门螺杆菌抗原CagA（细胞毒素相关基因产物A）的血清IgG抗体。在505例患者中，401例（79%）幽门螺杆菌抗体血清学检测呈阳性，而在1025名对照者中有740例（72%）呈阳性，冠心病的优势比为1.55（95%可信区间为1.19至2.03），在对标准血管危险因素和社会经济地位指标进行调整后，该优势比降至1.30（95%可信区间为0.88至1.90）。在冠心病患者中，240例（48%）针对CagA的IgG抗体血清学检测呈阳性，而对照者中有450例（44%）呈阳性。当将CagA血清学检测呈阳性的个体与幽门螺杆菌血清学检测呈阴性的个体进行比较时，冠心病的优势比为1.42（95%可信区间为1.06至1.91），调整后降至1.10（95%可信区间为0.71至1.71）。在一项仅限于1141名（75%）幽门螺杆菌血清学检测呈阳性参与者的分析中，CagA血清学检测呈阳性男性的冠心病优势比为1.0（95%可信区间为0.78至1.29）。未观察到幽门螺杆菌血清学阳性与血脂、血压、全身炎症标志物或血浆同型半胱氨酸之间存在强关联。
幽门螺杆菌感染与中老年男性冠心病的发病率无强关联，且CagA阳性菌株与该疾病的关联似乎并不比其他菌株更强。然而，需要进一步研究来证实或反驳是否存在任何中度关联，尤其是在较年轻年龄段。
