Gibbs R G, Sian M, Mitchell A W, Greenhalgh R M, Davies A H, Carey N
Department of Vascular Surgery and Radiology, Imperial College School of Medicine, Charing Cross Campus, London, UK.
Stroke. 2000 Dec;31(12):2930-5. doi: 10.1161/01.str.31.12.2930.
Research for infectious agents in the etiology of atherosclerosis has identified Chlamydia pneumoniae as a possible candidate. While there is evidence of an association between presence of this microorganism and atherosclerosis, it is unclear whether infection has a genuinely etiologic role in this disease, whether its presence influences clinical outcomes, and, if so, at which stages of disease this occurs. We have approached this issue in patients with advanced carotid artery atherosclerosis using molecular biological detection methods and clinically relevant indicators of pathology in carotid artery atheroma to determine whether the presence of C pneumoniae correlates with plaque instability.
C pneumoniae was detected with the use of a sensitive nested polymerase chain reaction. Preoperative embolization and preoperative infarcts were recorded with the use of transcranial Doppler insonation of the middle cerebral artery and cerebral CT, respectively.
C pneumoniae DNA was detected in 25.5% of a cohort of 98 symptomatic patients. There was no significant difference in plaque stability as measured by embolization rates between the chlamydial-positive and -negative specimens. There was also no correlation between the number of ipsilateral hemispheric infarcts in the territory of the middle cerebral artery and chlamydial status.
This study confirms that C pneumoniae is a common finding in atherosclerotic plaques of the carotid artery but suggests that the presence of the infectious organism has little detectable impact on plaque instability when measured by clinically significant markers. This raises important questions for the rationale of antibiotic therapy in atherosclerosis.
对动脉粥样硬化病因中感染因子的研究已将肺炎衣原体确定为一个可能的候选因素。虽然有证据表明这种微生物的存在与动脉粥样硬化之间存在关联，但尚不清楚感染在该疾病中是否真的具有病因学作用，其存在是否会影响临床结局，以及如果有影响，是在疾病的哪个阶段发生。我们采用分子生物学检测方法和颈动脉粥样硬化斑块中临床相关的病理学指标，对晚期颈动脉粥样硬化患者进行研究，以确定肺炎衣原体的存在是否与斑块不稳定性相关。
使用敏感的巢式聚合酶链反应检测肺炎衣原体。分别通过经颅多普勒超声检测大脑中动脉和脑部CT记录术前栓塞和术前梗死情况。
在98例有症状患者的队列中，25.5%检测到肺炎衣原体DNA。衣原体阳性和阴性标本的栓塞率所衡量的斑块稳定性无显著差异。大脑中动脉区域同侧半球梗死数量与衣原体状态之间也无相关性。
本研究证实肺炎衣原体在颈动脉粥样硬化斑块中很常见，但表明通过具有临床意义的标志物衡量时，感染性生物体的存在对斑块不稳定性几乎没有可检测到的影响。这对动脉粥样硬化抗生素治疗的理论依据提出了重要问题。
