在赫尔辛基心脏研究中，慢性肺炎衣原体感染作为冠心病的一个危险因素。

Chronic Chlamydia pneumoniae infection as a risk factor for coronary heart disease in the Helsinki Heart Study.

作者信息

Saikku P, Leinonen M, Tenkanen L, Linnanmäki E, Ekman M R, Manninen V, Mänttäri M, Frick M H, Huttunen J K

机构信息

University of Helsinki, Finland.

出版信息

Ann Intern Med. 1992 Feb 15;116(4):273-8. doi: 10.7326/0003-4819-116-4-273.

DOI:10.7326/0003-4819-116-4-273

PMID:1733381

Abstract

OBJECTIVE

To investigate in the prospective Helsinki Heart Study, whether chronic Chlamydia pneumoniae infection, indicated by elevated antibody titers against the pathogen, chlamydial lipopolysaccharide-containing immune complexes, or both, is a risk factor for coronary heart disease.

DESIGN AND SETTING

The Helsinki Heart Study was a randomized, double-blind, 5-year clinical trial to test the efficacy of gemfibrozil in reducing the risk for coronary heart disease. Participants were randomized to receive either gemfibrozil (2046 patients) or placebo (2035 patients). Fatal and nonfatal myocardial infarction and sudden cardiac death were the main study end points. Serum samples were collected at 3-month intervals from all patients.

PATIENTS

One hundred forty cardiac events occurred during the follow-up period. Serum samples from 103 case patients obtained 3 to 6 months before a cardiac end point were matched with those from controls for time point, locality, and treatment. Samples were tested for markers of chronic chlamydial infection.

MEASUREMENTS

Immunoglobulin A (IgA) and G (IgG) antibodies to C. pneumoniae were measured using the microimmunofluorescence method. Lipopolysaccharide-containing immune complexes were measured using two antigen-specific enzyme immunoassays, the lipopolysaccharide-capture and immunoglobulin M (IgM)-capture methods.

MAIN RESULTS

Using a conditional logistic regression model, odds ratios for the development of coronary heart disease were 2.7 (95% CI, 1.1 to 6.5) for elevated IgA titers, 2.1 (CI, 1.1 to 3.9) for the presence of immune complexes, and 2.9 (CI, 1.5 to 5.4) for the presence of both factors. If we adjusted for other coronary heart disease risk factors such as age, hypertension, and smoking, the corresponding values would be 2.3 (CI, 0.9 to 6.2), 1.8 (CI, 0.9 to 3.6), and 2.6 (CI, 1.3 to 5.2), respectively.

CONCLUSION

The results suggest that chronic C. pneumoniae infection may be a significant risk factor for the development of coronary heart disease.

摘要

目的

在前瞻性赫尔辛基心脏研究中，调查针对病原体的抗体滴度升高、含衣原体脂多糖的免疫复合物或两者所表明的慢性肺炎衣原体感染是否为冠心病的危险因素。

设计与背景

赫尔辛基心脏研究是一项随机、双盲、为期5年的临床试验，旨在测试吉非贝齐降低冠心病风险的疗效。参与者被随机分为接受吉非贝齐治疗组（2046例患者）或安慰剂组（2035例患者）。致命和非致命性心肌梗死以及心源性猝死是主要研究终点。每隔3个月从所有患者采集血清样本。

患者

随访期间发生了140例心脏事件。将103例病例患者在心脏终点事件前3至6个月采集的血清样本与对照组的血清样本在时间点、地点和治疗方面进行匹配。对样本进行慢性衣原体感染标志物检测。

测量

采用微量免疫荧光法检测肺炎衣原体的免疫球蛋白A（IgA）和G（IgG）抗体。采用两种抗原特异性酶免疫测定法，即脂多糖捕获法和免疫球蛋白M（IgM）捕获法，检测含脂多糖的免疫复合物。

主要结果

使用条件逻辑回归模型，IgA滴度升高时冠心病发生的比值比为2.7（95%可信区间，1.1至6.5），存在免疫复合物时为2.1（可信区间，1.1至3.9），两者均存在时为2.9（可信区间，1.5至5.4）。如果我们对年龄、高血压和吸烟等其他冠心病危险因素进行校正，相应的值分别为2.3（可信区间，0.9至6.2）、1.8（可信区间，0.9至3.6）和2.6（可信区间，1.3至5.2）。