不稳定型心绞痛患者动脉粥样硬化斑块中肺炎衣原体的患病率及其与血清学的关系。

Zamorano José, Suarez Avelina, Garcia Tejada Julio, Culebras Ester, Castañón Jose, Picazo Juan, Moreno Raúl, Sanchez-Harguindey Luis

Servicio de Cardiologia, Hospital Clinico San Carlos, Plaza Cristo Rey, 28040, Madrid, Spain.

Int J Cardiol. 2003 Jun;89(2-3):273-9. doi: 10.1016/s0167-5273(02)00507-7.

BACKGROUND

Chlamydia pneumoniae has been associated with coronary artery disease by both seroepidemiological studies, and by direct detection of the micro-organism in atherosclerotic lesions. This bacteria could play a potential role in the development of acute coronary events. We examined coronary arteries from patients with unstable angina in order to verify an endovascular presence of C. pneumoniae, and to determine if there is any relationship between serology of acute infection by this pathogen and its presence inside the atherosclerotic plaque of these patients.

METHODS

We analysed a total of 76 atherosclerotic plaques obtained from 45 patients who underwent coronary artery bypass surgery. In all patients unstable angina was present within the prior 3 weeks. The presence of C. pneumoniae in the plaque was determined by nested polymerase chain reaction (PCR). Antichlamydial immunoglobulin G (IgG), A (IgA) and M (IgM) was examined by microimmunofluorescence and compared to the PCR result.

FINDINGS

DNA of C. pneumoniae was detected in 57 (75%) of 76 atherosclerotic lesions. In most cases (74/76: 97%) a positive IgA, IgM or IgG result was seen. Seven (12%) and 54 (94%) of the 57 PCR positive plaques came from patients with a positive IgM and IgA result, respectively. There was no statistical significant difference between PCR positive and PCR negative plaques in patients with a positive or negative serological result. Clinical characteristics were similarly distributed in patients with and without infected lesions.

INTERPRETATION

C. pneumoniae organisms are frequently found in the atherosclerotic lesions of patients undergoing coronary surgery for unstable angina. Neither serological results of acute or recent infection by C. pneumoniae nor clinical characteristics are useful in predicting the individual risk of harbouring C. pneumoniae in the coronary lesions of patients with unstable angina.

背景

血清流行病学研究以及在动脉粥样硬化病变中直接检测微生物均表明，肺炎衣原体与冠状动脉疾病有关。这种细菌可能在急性冠状动脉事件的发生发展中起潜在作用。我们检查了不稳定型心绞痛患者的冠状动脉，以证实血管内存在肺炎衣原体，并确定该病原体的急性感染血清学与其在这些患者动脉粥样硬化斑块内的存在之间是否存在任何关联。

方法

我们分析了从45例行冠状动脉搭桥手术患者身上获取的总共76个动脉粥样硬化斑块。所有患者在术前3周内均患有不稳定型心绞痛。通过巢式聚合酶链反应（PCR）确定斑块中肺炎衣原体的存在。通过微量免疫荧光法检测抗衣原体免疫球蛋白G（IgG）、A（IgA）和M（IgM），并与PCR结果进行比较。

结果

在76个动脉粥样硬化病变中的57个（75%）检测到肺炎衣原体DNA。在大多数情况下（74/76：97%），IgA、IgM或IgG检测结果为阳性。57个PCR阳性斑块中，分别有7个（12%）和54个（94%）来自IgM和IgA检测结果为阳性的患者。血清学结果为阳性或阴性的患者中，PCR阳性和PCR阴性斑块之间无统计学显著差异。有感染性病变和无感染性病变的患者临床特征分布相似。