Guech-Ongey Mercy, Brenner Hermann, Twardella Dorothee, Rothenbacher Dietrich
Department of Epidemiology, German Centre for Research on Ageing, University of Heidelberg, Heidelberg, Germany.
BMC Cardiovasc Disord. 2006 Apr 12;6:17. doi: 10.1186/1471-2261-6-17.
There have been suggestions of an association between Chlamydia pneumoniae, chlamydial heat shock protein (Ch-hsp) 60 and human heat shock protein (h-hsp) 60 infection sero-status and development of secondary cardiovascular events. Patients with diabetes might be at higher risk since they are prone to infections. The objective of this study was to investigate prospectively the role of Chlamydia pneumoniae (CP), chlamydial heat shock protein (Ch-hsp) 60 and a possible intermediate role of human heat shock protein (h-hsp) 60 sero-status in the development of secondary cardiovascular disease (CVD) events in patients with coronary heart disease (CHD) under special consideration of diabetes mellitus.
Patients aged 30-70 undergoing an in-patient rehabilitation program after acute manifestation of coronary heart disease (International Classification of Disease, 9th Rev. pos. 410-414) between January 1999 and May 2000 in one of two participating rehabilitation clinics in Germany were included in this analysis. Chlamydia pneumoniae (CP), chlamydial heat shock protein (Ch-hsp) 60 and human heat shock protein (h-hsp) 60 status at baseline were measured by serum immunoglobulin G and A antibodies. Secondary CVD events (myocardial infarction, stroke, and cardiovascular death) were recorded during a mean follow-up period of 33.5 months (response = 87%).
Among the 1052 subjects 37.4% and 39.3% were sero-positive to CP IgA and IgG respectively, 22.2% were sero-positive to Ch-hsp 60 IgG and 8.4% were positive to h-hsp 60 IgG at baseline. During follow-up, secondary CVD events occurred among 71 (6.8%) participants. Occurrence of a secondary CVD event was more common among CP (IgA) and CP (IgG) sero-positive than among sero-negative patients (p-values 0.04 and 0.1, respectively). The risk of secondary CVD events was increased among patients with both a positive CP sero-status and diabetes compared to infection negative, non-diabetic patients and in general, sero-positivity added a hazard to diabetes. The interaction term between infection sero-status and diabetes was not statistically significant. We were not able to show an intermediate role of human heat shock protein (h-hsp) 60 sero-status in the development of secondary CVD events in patients with CHD.
Results from this cohort of 1052 patients with pre-existing CHD cannot exclude a possible moderate increase in risk of secondary CVD events among patients with a positive infection sero-status. However, our study showed no intermediate role of human heat shock protein (h-hsp) 60 sero-status in the development of secondary CVD events in patients with CHD. Larger studies or meta-analysis of multiple studies are needed to address the interaction between infection sero-status and diabetes with adequate power.
有观点认为肺炎衣原体、衣原体热休克蛋白（Ch-hsp）60和人类热休克蛋白（h-hsp）60感染血清状态与继发性心血管事件的发生之间存在关联。糖尿病患者可能因易于感染而面临更高风险。本研究的目的是前瞻性地调查肺炎衣原体（CP）、衣原体热休克蛋白（Ch-hsp）60以及人类热休克蛋白（h-hsp）60血清状态在冠心病（CHD）患者继发性心血管疾病（CVD）事件发生过程中可能的中间作用，并特别考虑糖尿病因素。
纳入1999年1月至2000年5月期间在德国两家参与研究的康复诊所之一接受急性冠心病发作（国际疾病分类第9版，编码410 - 414）后住院康复计划的30 - 70岁患者进行分析。通过血清免疫球蛋白G和A抗体检测基线时的肺炎衣原体（CP）、衣原体热休克蛋白（Ch-hsp）60和人类热休克蛋白（h-hsp）60状态。在平均33.5个月的随访期内记录继发性CVD事件（心肌梗死、中风和心血管死亡）（应答率 = 87%）。
在1052名受试者中，基线时CP IgA和IgG血清阳性率分别为37.4%和39.3%，Ch-hsp 60 IgG血清阳性率为22.2%，h-hsp 60 IgG阳性率为8.4%。随访期间，71名（6.8%）参与者发生了继发性CVD事件。CP（IgA）和CP（IgG）血清阳性患者中继发性CVD事件的发生率高于血清阴性患者（p值分别为0.04和0.1）。与感染阴性、非糖尿病患者相比，CP血清状态阳性且患有糖尿病的患者发生继发性CVD事件的风险增加，总体而言，血清阳性增加了糖尿病患者的风险。感染血清状态与糖尿病之间的交互项无统计学意义。我们未能证明人类热休克蛋白（h-hsp）60血清状态在冠心病患者继发性CVD事件发生过程中的中间作用。
这组1052例已有冠心病的患者的研究结果不能排除感染血清状态阳性患者继发性CVD事件风险可能适度增加的情况。然而，我们的研究表明人类热休克蛋白（h-hsp）60血清状态在冠心病患者继发性CVD事件发生过程中无中间作用。需要更大规模的研究或对多项研究进行荟萃分析，以充分有力地探讨感染血清状态与糖尿病之间的相互作用。
