Zhu J, Quyyumi A A, Norman J E, Csako G, Waclawiw M A, Shearer G M, Epstein S E
Cardiovascular Research Institute, Washington Hospital Center, DC 20010, USA.
Am J Cardiol. 2000 Jan 15;85(2):140-6. doi: 10.1016/s0002-9149(99)00653-0.
Infection and inflammation have been suggested to play roles in coronary artery disease (CAD). We hypothesized that: (1) CAD risk is associated with the aggregate number of pathogens (pathogen burden), and (2) increased pathogen burden is associated with elevated levels of C-reactive protein (CRP), a marker of inflammation. We evaluated 233 patients for CAD. Blood samples from each patient were tested for immunoglobulin-G (IgG) antibodies to cytomegalovirus (CMV), Chlamydia pneumoniae, hepatitis A virus (HAV), herpes simplex virus type 1 (HSV-1) and HSV type 2 (HSV-2), and for the CRP levels. Of the 233 study subjects, 68% had evidence of CAD by coronary angiography. Although the prevalence of seropositivity for each pathogen tended to be higher in the patients with CAD than those without, only the association between CAD and seropositivity to HAV was significant in multivariate analysis. Over 75% of study subjects had been exposed to > or =3 of the 5 pathogens tested, and analysis determined that increasing pathogen burden was significantly associated with increasing CAD risk, even after adjustment for traditional CAD risk factors. The prevalence of CAD was 48%, 69%, and 85% in individuals with antibodies to < or =2 pathogens, to 3 or 4 pathogens, and to 5 pathogens, respectively. A similar association between increasing pathogen burden and CRP levels was also found. The pathogen burden remained a significant predictor of CRP levels after multivariate analysis. Our data suggest that infection does play a role in the genesis of atherosclerosis. However, the risk posed by infection is related to the pathogen burden that may contribute to CAD through inflammatory responses.
感染和炎症被认为在冠状动脉疾病（CAD）中发挥作用。我们假设：（1）CAD风险与病原体总数（病原体负荷）相关，（2）病原体负荷增加与炎症标志物C反应蛋白（CRP）水平升高相关。我们对233例患者进行了CAD评估。检测了每位患者血液样本中的巨细胞病毒（CMV）、肺炎衣原体、甲型肝炎病毒（HAV）、单纯疱疹病毒1型（HSV-1）和单纯疱疹病毒2型（HSV-2）的免疫球蛋白G（IgG）抗体以及CRP水平。在233名研究对象中，68%通过冠状动脉造影有CAD证据。虽然CAD患者中每种病原体血清阳性率往往高于无CAD患者，但在多变量分析中只有CAD与HAV血清阳性之间的关联具有统计学意义。超过75%的研究对象曾接触过所检测的5种病原体中的≥3种，分析确定即使在对传统CAD危险因素进行校正后，病原体负荷增加仍与CAD风险增加显著相关。抗体针对≤2种病原体、3或4种病原体以及5种病原体的个体中，CAD患病率分别为48%、69%和85%。在病原体负荷增加与CRP水平之间也发现了类似的关联。多变量分析后，病原体负荷仍是CRP水平的显著预测指标。我们的数据表明感染确实在动脉粥样硬化的发生中起作用。然而，感染带来的风险与病原体负荷有关，病原体负荷可能通过炎症反应导致CAD。
