慢性肺炎衣原体感染会增加心肌损伤风险吗？来自非ST段抬高型急性冠状动脉综合征患者的见解。

Does chronic Chlamydia pneumoniae infection increase the risk of myocardial injury? Insights from patients with non-ST-elevation acute coronary syndromes.

作者信息

Wong Brian Y L, Gnarpe Judy, Teo Koon K, Ohman E Magnus, Prosser Connie, Gibler W Brian, Langer Anatoly, Chang Wei-Ching, Armstrong Paul W

机构信息

University of Alberta, Edmonton, Alberta, Canada.

出版信息

Am Heart J. 2002 Dec;144(6):987-94. doi: 10.1067/mhj.2002.126734.

DOI:10.1067/mhj.2002.126734

PMID:12486422

Abstract

BACKGROUND

Cumulative evidence suggests a positive association between Chlamydia pneumoniae (Cpn) infection and risk of future coronary events among patients with stable coronary artery disease. However, its prognostic role in unstable coronary syndromes is less well defined. Because Cpn immunoglobulin A (IgA) may be a more reliable indicator of chronic infection than immunoglobulin G (IgG), we speculated that in patients with non-ST-elevation acute coronary syndromes (ACS), this marker might serve as a more useful prognostic tool. Accordingly, we evaluated plasma samples acquired at presentation in 178 patients with ACS for a possible association between Cpn IgA titer and biochemical evidence of myocardial injury.

METHODS

Cpn IgG (positive if > or =1:32), and IgA titers (positive if > or =1:16) were measured by use of the microimmunofluorescence technique in 70 patients with ACS in whom myocardial injury developed associated with their presenting events (elevated CK-MB and/or troponin I); and in 108 patients with ACS without such injury. The odds ratios (ORs) for myocardial injury associated with consecutive antibody titers were determined for each of Cpn IgG and IgA. Multiple logistic regression was applied to adjust for key baseline characteristics.

RESULTS

Median age of subjects was 64 years; 63% were male and 33% were smokers. The median antibody titers among those with and without myocardial injury respectively were as follows: IgG (1:128 vs 1:128), IgA (1:32 vs <1:16, P =.2). The adjusted ORs for myocardial injury associated with consecutive IgA titers were as follows: IgA > or =1:16, adjusted OR 1.49 (P =.22); > or =1:32, OR 1.95 (P =.04); > or =1:64, OR 1.37 (P =.38); > or =1:128, OR 0.77 (P =.55). No significant trend was found for any IgG titer.

CONCLUSIONS

Among patients with non-ST-elevation ACS, a Cpn IgA > or =1:32 at presentation was associated with a significantly higher risk of myocardial injury complicating the presenting event.

摘要

背景

越来越多的证据表明，肺炎衣原体（Cpn）感染与稳定型冠状动脉疾病患者未来发生冠状动脉事件的风险之间存在正相关。然而，其在不稳定型冠状动脉综合征中的预后作用尚不明确。由于Cpn免疫球蛋白A（IgA）可能比免疫球蛋白G（IgG）更可靠地反映慢性感染，我们推测在非ST段抬高型急性冠状动脉综合征（ACS）患者中，该标志物可能是一种更有用的预后工具。因此，我们评估了178例ACS患者就诊时采集的血浆样本，以确定Cpn IgA滴度与心肌损伤生化证据之间的可能关联。

方法

采用微量免疫荧光技术检测70例ACS患者（其心肌损伤与就诊时事件相关，CK-MB和/或肌钙蛋白I升高）以及108例无此类损伤的ACS患者的Cpn IgG（滴度≥1:32为阳性）和IgA滴度（滴度≥1:16为阳性）。分别确定Cpn IgG和IgA与连续抗体滴度相关的心肌损伤比值比（OR）。应用多因素逻辑回归对关键基线特征进行校正。

结果

受试者的中位年龄为64岁；63%为男性，33%为吸烟者。有心肌损伤和无心肌损伤患者的中位抗体滴度分别如下：IgG（1:128对1:128），IgA（1:32对<1:16，P = 0.2）。与连续IgA滴度相关的心肌损伤校正OR如下：IgA≥1:16，校正OR 1.49（P = 0.22）；≥1:32，OR 1.95（P = 0.04）；≥1:64，OR 1.37（P = 0.38）；≥1:128，OR 0.77（P = 0.55）。未发现任何IgG滴度有显著趋势。