Katsenis C, Kouskouni E, Kolokotronis L, Rizos D, Dimakakos P
Department of Vascular Surgery, 2nd Surgical Clinic, Aretaieion Hospital, University of Athens, Greece.
Angiology. 2001 Sep;52(9):615-9. doi: 10.1177/000331970105200905.
An association between symptomatic carotid stenosis and recent infection with Chlamydia pneumoniae is reported. Thirty-five patients (20 symptomatic and 15 asymptomatic) with carotid stenosis of 70% to 90% underwent carotid endarterectomy. Endarterectomy was performed without patch and shunt; the average occlusion time of the internal carotid artery was 14 +/- 3 min. The atheromatic plaque and a portion of the thyroid artery were examined with polymerase chain reaction and peripheral vein blood was obtained for serologic detection of systematic infection, and IgG and IgM antibodies to C. pneumoniae by enzyme-linked immunosorbent assay. Twenty of 35 patients (57.1%) had increased titers of IgG antibodies to C. pneumoniae. Eight patients revealed IgG plus IgM antibodies; two of the eight had IgG, IgM, and positive findings on polymerase chain reaction. No C. pneumoniae was detected on the thyroid arteries. Sixty-five percent (13/20) of the patients with increased IgG antibodies to C. pneumoniae, 87.5% (7/8) with IgG + IgM, and 100% with IgG + IgM + positive polymerase chain reaction were symptomatic. Plaque morphology in association with symptoms did not reveal a significant correlation between soft plaques and symptoms, whereas the majority of the symptomatic patients had plaques of type III-V. Patients having recent contamination and positive polymerase chain reaction had a significant relationship between C. pneumoniae infection and symptomatic carotid disease. This supports the hypothesis that C. pneumoniae infection can produce a kind of instability of the carotid plaque. The results of this study demonstrate that patients with advanced atherosclerotic carotid disease have an increased incidence of C. pneumoniae infection. Recent infection could be responsible for instability of the carotid plaque, causing cerebral ischemic episodes.
据报道，有症状的颈动脉狭窄与近期肺炎衣原体感染之间存在关联。35例（20例有症状，15例无症状）颈动脉狭窄70%至90%的患者接受了颈动脉内膜切除术。内膜切除术未使用补片和分流管；颈内动脉平均阻断时间为14±3分钟。采用聚合酶链反应检测动脉粥样硬化斑块和部分甲状腺动脉，并采集外周静脉血进行系统感染的血清学检测，通过酶联免疫吸附测定法检测肺炎衣原体的IgG和IgM抗体。35例患者中有20例（57.1%）肺炎衣原体IgG抗体滴度升高。8例患者检测出IgG加IgM抗体；其中2例同时有IgG、IgM抗体且聚合酶链反应结果呈阳性。在甲状腺动脉中未检测到肺炎衣原体。肺炎衣原体IgG抗体升高的患者中65%（13/20）有症状，IgG + IgM抗体的患者中87.5%（7/8）有症状，IgG + IgM抗体且聚合酶链反应阳性的患者100%有症状。斑块形态与症状之间的关系显示，软斑块与症状之间无显著相关性，而大多数有症状的患者有III - V型斑块。近期有感染且聚合酶链反应阳性的患者，肺炎衣原体感染与有症状的颈动脉疾病之间存在显著关联。这支持了肺炎衣原体感染可导致颈动脉斑块某种不稳定性的假说。本研究结果表明，晚期动脉粥样硬化性颈动脉疾病患者肺炎衣原体感染发生率增加。近期感染可能是颈动脉斑块不稳定的原因，导致脑缺血发作。
