Kaden Jens J, Bickelhaupt Svetlana, Grobholz Rainer, Brueckmann Martina, Haase Karl K, Dempfle Carl-Erik, Borggrefe Martin
1st Department of Medicine (Cardiology, Angiology, and Pneumology), University Hospital of Mannheim, University of Heidelberg, Germany.
J Heart Valve Dis. 2003 Jul;12(4):447-53.
Non-rheumatic, calcific aortic stenosis (AS) is the most prevalent heart valve disease in the elderly. It is based on a chronic inflammatory process with infiltration and activation of leukocytes, and a rise in systemic inflammatory markers. An association with Chlamydia pneumoniae infection has been discussed, but previous studies have yielded divergent results.
Tricuspid aortic valves with calcific AS were obtained from patients undergoing aortic valve replacement. Control valves from patients matched for age and cardiovascular risk factors were obtained at autopsy. Immunohistochemistry was performed using monoclonal antibodies directed against C. pneumoniae and against leukocyte common antigen. Cultured HEp-2 cells infected with C. pneumoniae were used as positive controls.
Positive immunostaining for C. pneumoniae was demonstrated in 12 of 14 (86%) stenotic valves and in six of nine (67%) control valves. Immunostained cells were located mainly in cell- and leukocyte-rich areas. Although stenotic valves showed a higher staining intensity as assessed by semiquantitative scoring (1.8 +/- 0.4 versus 0.8 +/- 0.2 units, p < 0.05), there was no statistically significant difference between stenotic and control valves regarding the presence of C. pneumoniae (p = 0.90).
Positive immunostaining for C. pneumoniae was not associated with the presence of calcific AS. As in previous serologic and molecular biology studies, a high prevalence of C. pneumoniae in the adult population was demonstrated, irrespective of heart valve disease. Thus, C. pneumoniae is most likely not involved in the pathogenesis of calcific aortic stenosis.
非风湿性钙化性主动脉瓣狭窄（AS）是老年人中最常见的心脏瓣膜疾病。它基于一种慢性炎症过程，伴有白细胞浸润和活化，以及全身炎症标志物升高。曾讨论过与肺炎衣原体感染的关联，但先前的研究结果不一。
从接受主动脉瓣置换术的患者中获取伴有钙化性AS的三尖瓣主动脉瓣。在尸检时获取年龄和心血管危险因素相匹配患者的对照瓣膜。使用针对肺炎衣原体和白细胞共同抗原的单克隆抗体进行免疫组织化学检测。用感染肺炎衣原体的培养人喉表皮样癌细胞（HEp-2细胞）作为阳性对照。
14个狭窄瓣膜中有12个（86%）肺炎衣原体免疫染色呈阳性，9个对照瓣膜中有6个（67%）呈阳性。免疫染色细胞主要位于富含细胞和白细胞的区域。尽管通过半定量评分评估，狭窄瓣膜显示出更高的染色强度（1.8±0.4对0.8±0.2单位，p<0.05），但在狭窄瓣膜和对照瓣膜中肺炎衣原体的存在情况无统计学显著差异（p = 0.90）。
肺炎衣原体免疫染色阳性与钙化性AS的存在无关。与先前的血清学和分子生物学研究一样，无论是否患有心脏瓣膜疾病，在成年人群中肺炎衣原体的患病率都很高。因此，肺炎衣原体很可能不参与钙化性主动脉瓣狭窄的发病机制。
