Lentine Krista L, Parsonnet Julie, Taylor Isabella, Wrone Elizabeth M, Lafayette Richard A
Saint Louis University Center for Outcomes Research Salus Center, 2nd Floor, 3545 Lafayette Avenue, MO 63104, USA.
Clin Exp Nephrol. 2006 Mar;10(1):55-62. doi: 10.1007/s10157-005-0392-5.
Inflammatory markers predict cardiovascular risk and mortality in endstage renal disease. The relationship of chronic infections to inflammation and vascular disease events has not been reported among American dialysis patients.
We performed a cross-sectional and prospective study of a multiracial cohort of 97 chronic hemodialysis patients in California. Anti-Chlamydia pneumoniae IgA and IgG antibodies (Cp-IgA and Cp-IgG), anti-Helicobacter pylori antibodies (Hp-IgG), and highly sensitive C-reactive protein (hsCRP) levels were measured at enrollment. We ascertained the prevalence of atherosclerotic vascular (coronary artery, cerebrovascular, and peripheral vascular) disease (AVD) events, and observed participants for at least 1 year for incident events and mortality. We defined statistical significance as P < 0.01.
Elevated hsCRP levels (77%) and seropositivity to C. pneumoniae were common (Cp-IgA, 49%; Cp-IgG, 64%), whereas the seroprevalence of Hp-IgG was relatively low (25%). The hsCRP levels did not vary with infection status. In bivariate analysis, Cp-IgA and Cp-IgG were each associated with approximately fourfold higher odds of prevalent AVD (P < 0.01). Although anti-chlamydial antibodies maintained nearly significant associations with AVD after covariate adjustment (P < 0.05), antibodies did not predict outcomes over the period of observation. However, hsCRP was a nearly significant independent predictor of prevalent AVD (P = 0.02) and of mortality during follow-up (P = 0.01). We did not detect an association of Hp-IgG with any study outcome.
Our findings generalize a possible link between C. pneumoniae and prevalent atherosclerosis in American hemodialysis patients and confirm the importance of hsCRP as a prognostic indicator. Our work does not support H. pylori as an important mediator of cardiovascular risk in dialysis patients.
炎症标志物可预测终末期肾病患者的心血管风险和死亡率。美国透析患者中慢性感染与炎症及血管疾病事件之间的关系尚未见报道。
我们对加利福尼亚州97名慢性血液透析患者的多种族队列进行了横断面和前瞻性研究。在入组时测量抗肺炎衣原体IgA和IgG抗体（Cp-IgA和Cp-IgG）、抗幽门螺杆菌抗体（Hp-IgG）以及高敏C反应蛋白（hsCRP）水平。我们确定了动脉粥样硬化性血管（冠状动脉、脑血管和外周血管）疾病（AVD）事件的患病率，并对参与者进行至少1年的观察，以了解新发事件和死亡率。我们将统计学显著性定义为P < 0.01。
hsCRP水平升高（77%）和肺炎衣原体血清阳性很常见（Cp-IgA为49%；Cp-IgG为64%），而Hp-IgG的血清阳性率相对较低（25%）。hsCRP水平与感染状态无关。在双变量分析中，Cp-IgA和Cp-IgG各自与AVD患病率增加约四倍相关（P < 0.01）。尽管在进行协变量调整后，抗衣原体抗体与AVD仍保持近乎显著的关联（P < 0.05），但在观察期内抗体并不能预测结局。然而，hsCRP是AVD患病率（P = 0.02）和随访期间死亡率（P = 0.01）的近乎显著的独立预测因子。我们未检测到Hp-IgG与任何研究结局之间的关联。
我们的研究结果揭示了美国血液透析患者中肺炎衣原体与动脉粥样硬化之间可能存在的联系，并证实了hsCRP作为预后指标的重要性。我们的研究并不支持幽门螺杆菌是透析患者心血管风险的重要介导因素这一观点。
