老年卒中患者中的肺炎衣原体（C-PEPS）：一项关于急性脑血管病老年患者肺炎衣原体血清流行率的病例对照研究

Chlamydia pneumoniae in elderly patients with stroke (C-PEPS): a case-control study on the seroprevalence of Chlamydia pneumoniae in elderly patients with acute cerebrovascular disease.

作者信息

Ngeh Joseph, Gupta Sandeep, Goodbourn Colin, Panayiotou Barnabas, McElligott Geraldine

机构信息

Department of Medicine for Elderly People, Whipps Cross University Hospital, London, UK.

出版信息

Cerebrovasc Dis. 2003;15(1-2):11-6. doi: 10.1159/000067115.

DOI:10.1159/000067115

PMID:12499705

Abstract

BACKGROUND AND PURPOSE

Multiple studies have suggested an association between Chlamydia pneumoniae infection and atherosclerotic vascular disease. We investigated whether serological markers of C. pneumoniae infection were associated with acute stroke or transient ischaemic attack (TIA), exclusively in elderly patients.

METHODS

One-hundred white patients aged over 65 years admitted with acute stroke or TIA, and 87 control patients admitted with acute non-cardiopulmonary, non-infective disorders were recruited prospectively. Using an enzyme-linked immunosorbent assay kit, the presence of C. pneumoniae immunoglobulins IgA, IgG, IgM in patients' sera was determined.

RESULTS

The seroprevalence of C. pneumoniae-specific IgA, IgG, IgM were 63, 71, and 14% in the stroke/TIA group (median age = 80), and 62, 65, and 17% in the control group (median age = 80), respectively. Using a logistic regression statistical model, adjusting for age and sex, history of hypertension, smoking, diabetes, ischaemic heart disease (IHD), ischaemic electrocardiogram (ECG), the odds ratios (ORs) of having a stroke/TIA in relation to C. pneumoniae-specific IgA, IgG, IgM were 1.04, 1.24, 0.79 (p = NS). Further analysis identified 43 acute stroke/TIA cases and 44 controls without history of IHD or ischaemic ECG or both. After adjusting for history of hypertension, smoking, diabetes, age and sex, the ORs in this subgroup were 1.40 for IgA [95% confidence interval (CI) 0.53-3.65; p = 0.49], 2.41 for IgG (95% CI 0.90-6.46; p = 0.08) and 1.55 for IgM (95% CI 0.45-5.40; p = 0.49).

CONCLUSIONS

Although a high seroprevalence of C. pneumoniae in elderly patients was confirmed, no significant association between serological markers of C. pneumoniae infection and acute cerebrovascular events was found. There was, however, a weak trend towards increased ORs for acute cerebrovascular disease in a subgroup of C. pneumoniae seropositive elderly patients without any history of IHD or ischaemic ECG.

摘要

背景与目的

多项研究表明肺炎衣原体感染与动脉粥样硬化性血管疾病之间存在关联。我们专门针对老年患者，研究了肺炎衣原体感染的血清学标志物是否与急性卒中或短暂性脑缺血发作（TIA）相关。

方法

前瞻性招募了100例年龄超过65岁、因急性卒中和TIA入院的白人患者，以及87例因急性非心肺、非感染性疾病入院的对照患者。使用酶联免疫吸附测定试剂盒，检测患者血清中肺炎衣原体免疫球蛋白IgA、IgG、IgM的存在情况。

结果

卒中/TIA组（中位年龄 = 80岁）中肺炎衣原体特异性IgA、IgG、IgM的血清阳性率分别为63%、71%和14%，对照组（中位年龄 = 80岁）中分别为62%、65%和17%。使用逻辑回归统计模型，对年龄、性别、高血压病史、吸烟、糖尿病、缺血性心脏病（IHD）、缺血性心电图（ECG）进行校正后，与肺炎衣原体特异性IgA、IgG、IgM相关的发生卒中/TIA的比值比（OR）分别为1.04、1.24、0.79（p = 无统计学意义）。进一步分析确定了43例急性卒中和TIA病例以及44例无IHD或缺血性ECG病史或两者均无的对照。在对高血压病史、吸烟、糖尿病、年龄和性别进行校正后，该亚组中IgA的OR为1.40[95%置信区间（CI）0.53 - 3.65；p = 0.49]，IgG为2.41（95%CI 0.90 - 6.46；p = 0.08），IgM为1.55（95%CI 0.45 - 5.40；p = 0.49）。