Kosaka C, Hara K, Komiyama Y, Takahashi H
Department of Clinical Sciences and Laboratory Medicine, Kansai Medical University, Osaka, Japan.
Jpn Circ J. 2000 Nov;64(11):819-24. doi: 10.1253/jcj.64.819.
Chlamydia pneumoniae, a common human respiratory pathogen, has been implicated in the pathogenesis of coronary heart diseases (CHD) in several seroepidemiological studies. The present case-control study investigated the relation between serologic evidence of C. pneumoniae infection and CHD in a Japanese population. Two groups of cases were enrolled: 26 patients with acute myocardial infarction (AMI) and 46 patients with effort angina pectoris (e-AP). Their data were compared with 58 age-matched healthy controls and also compared with 53 patients with vasospastic angina (VSA) as pathological control subjects. Anti-C. pneumoniae specific IgA and IgG antibody titers were measured by enzyme-linked immunosorbent assay (ELISA). The mean indices of IgG-type antibody in AMI and e-AP were not significantly different from those in either the normal controls or VSA group. On the other hand, the mean indices of IgA-type antibody in AMI were significantly higher than in the normal controls (1.39+/-0.83 in AMI vs 0.84+/-0.58 in controls, p<0.001) and VSA (1.39+/-0.83 in AMI vs 1.05+/-0.61 in VSA, p<0.05) group. However, the differences in the IgA titers in the e-AP group compared with the normal controls did not reach a significant level. The odds ratio associated with the seropositivity of IgA for AMI against the normal controls was 3.89 (95% confidence interval (CI): 1.16-13.10) and that against VSA was 6.90 (95% CI: 1.73-27.52) after adjustment for risk factors for CHD and/or age, sex and smoking status. In 6 patients the elevated IgA titers were sustained even at 3 months after the episode of AMI. These results suggest that seropositivity for IgA-type antibody against C. pneumoniae may be a significant risk factor for the development of AMI. The possible mechanisms include chronic inflammation in the coronary artery due to persistent C. pneumoniae infection.
肺炎衣原体是一种常见的人类呼吸道病原体，在多项血清流行病学研究中，它被认为与冠心病（CHD）的发病机制有关。本病例对照研究调查了日本人群中肺炎衣原体感染的血清学证据与冠心病之间的关系。研究纳入了两组病例：26例急性心肌梗死（AMI）患者和46例劳力性心绞痛（e-AP）患者。他们的数据与58名年龄匹配的健康对照者进行了比较，同时也与53例血管痉挛性心绞痛（VSA）患者作为病理对照进行了比较。通过酶联免疫吸附测定（ELISA）测量抗肺炎衣原体特异性IgA和IgG抗体滴度。AMI组和e-AP组中IgG型抗体的平均指数与正常对照组或VSA组相比，差异均无统计学意义。另一方面，AMI组中IgA型抗体的平均指数显著高于正常对照组（AMI组为1.39±0.83，对照组为0.84±0.58，p<0.001）和VSA组（AMI组为1.39±0.83，VSA组为1.05±0.61，p<0.05）。然而，e-AP组与正常对照组相比，IgA滴度的差异未达到显著水平。在对冠心病危险因素和/或年龄、性别及吸烟状况进行调整后，AMI组相对于正常对照组，IgA血清阳性的比值比为3.89（95%置信区间（CI）：1.16 - 13.10），相对于VSA组为6.90（95%CI：1.73 - 27.52）。在6例患者中，即使在AMI发作3个月后，IgA滴度仍持续升高。这些结果表明，抗肺炎衣原体IgA型抗体血清阳性可能是AMI发生的一个重要危险因素。可能的机制包括肺炎衣原体持续感染导致冠状动脉的慢性炎症。
