幽门螺杆菌、肺炎衣原体与心肌梗死

Helicobacter pylori, Chlamydia pneumoniae and myocardial infarction.

作者信息

Fraser A G, Scragg R K, Cox B, Jackson R T

机构信息

University Department of Medicine, University of Auckland, Auckland, New Zealand.

出版信息

Intern Med J. 2003 Jul;33(7):267-72. doi: 10.1046/j.1445-5994.2003.00349.x.

DOI:10.1046/j.1445-5994.2003.00349.x

PMID:12823670

Abstract

BACKGROUND

Several epidemiological studies have suggested a positive association of coronary heart disease with both Helicobacter pylori and Chlamydia pneumoniae infection. The issue has been difficult to resolve because of the potential impact of several confounding factors, in particular, socioeconomic status for H. pylori and smoking for C. pneumoniae.

METHODS

A case-control study was carried out of 341 patients with a recent myocardial infarction (MI) and 831 community controls who had serology tests for H. pylori and C. pneumoniae (selected from a total study number of 1745 subjects). Individuals of Pacific Island or Maori ethnicity were excluded because they were infrequent.

RESULTS

H. pylori seropositivity was associated with increasing age (P < 0.001) and lower household income (P = 0.0003) but not with gender, smoking status or alcohol intake. H. pylori was associated with lower high-density lipoprotein cholesterol (P = 0.007) and a higher body mass index (P = 0.007). The overall seropositivity for H. pylori was 41.6% for patients with MI and 34.5% for age and sex-matched population controls. The odds ratio was 1.34 (95% confidence interval (CI): 1.00-1.80; P = 0.038) after adjusting for age and sex. C. pneumoniae seropositivity was significantly associated with male sex, younger age (P = 0.03) and smoking status (P = 0.004) but not associated with household income or any other measured risk factor for coronary heart disease. The overall seropositivity for C. pneumoniae was 51.2% for patients with recent MI and 43.5% for controls. After adjusting for age and sex, the odds ratio was 1.24 (95%CI: 0.95-1.62; P = 0.11). Subgroup analysis showed no clear pattern within different age groups. In particular, the odds ratio for H. pylori seropositivity in younger subjects (aged 35-49 years) was similar to the overall group (1.38; 95%CI: 0.83-2.29).

CONCLUSION

The association between H. pylori or C. pneumoniae seropositivity and coronary heart disease was significant but may not indicate a causal association.

摘要

背景

多项流行病学研究表明，冠心病与幽门螺杆菌和肺炎衣原体感染均呈正相关。由于多种混杂因素的潜在影响，该问题难以解决，尤其是幽门螺杆菌感染方面的社会经济地位因素以及肺炎衣原体感染方面的吸烟因素。

方法

对341例近期发生心肌梗死（MI）的患者和831例社区对照者进行了一项病例对照研究，这些对照者接受了幽门螺杆菌和肺炎衣原体的血清学检测（从总共1745名研究对象中选取）。太平洋岛民或毛利族个体被排除，因为他们数量较少。

结果

幽门螺杆菌血清阳性与年龄增加（P < 0.001）和家庭收入较低（P = 0.0003）相关，但与性别、吸烟状况或饮酒量无关。幽门螺杆菌与较低的高密度脂蛋白胆固醇水平（P = 0.007）和较高的体重指数（P = 0.007）相关。MI患者中幽门螺杆菌的总体血清阳性率为41.6%，年龄和性别匹配的人群对照为34.5%。在调整年龄和性别后，比值比为1.34（95%置信区间（CI）：1.00 - 1.80；P = 0.038）。肺炎衣原体血清阳性与男性、较年轻年龄（P = 0.03）和吸烟状况（P = 0.004）显著相关，但与家庭收入或任何其他测量的冠心病危险因素无关。近期MI患者中肺炎衣原体的总体血清阳性率为51.2%，对照为43.5%。在调整年龄和性别后，比值比为1.24（95%CI：0.95 - 1.62；P = 0.11）。亚组分析在不同年龄组中未显示出明确模式。特别是，较年轻受试者（35 - 49岁）中幽门螺杆菌血清阳性的比值比与总体组相似（1.38；95%CI：0.83 - 2.29）。