Valtonen V V
Second Department of Medicine, Helsinki University Central Hospital, Finland.
Ann Med. 1991;23(5):539-43. doi: 10.3109/07853899109150515.
A growing amount of clinical and experimental evidence suggests a link between infection and atherosclerotic diseases including both myocardial and cerebral infarction. A prime example is a greatly increased risk of stroke in septicaemic patients with and without endocarditis. Controlled clinical studies have recently shown, however, that certain other milder bacterial infections are also a risk factor for infarction. A preceding febrile respiratory infection was a major risk factor for stroke in young and middle aged patients. In patients with acute myocardial infarction Chlamydia pneumoniae and dental infections seem to be risk factors according to one controlled clinical study. Several possible mechanisms could explain the observed association of infection and infarction. For instance, infection causes a hypercoagulable state which increases the risk of thrombosis. In addition, infection has profound and harmful effects on prostaglandin and lipid metabolism. Infection may also have some role in the atherosclerotic process itself by inducing damage and inflammation in vascular endothelium in the presence of hypercholesterolemia. So far, however, little clinical evidence is available to suggest that by controlling infection the risk of infarction or development of atherosclerotic lesions might be reduced except in patients with endocarditis, where the risk of thromboembolic complications rapidly diminished when the infection is controlled with antimicrobial therapy.
越来越多的临床和实验证据表明，感染与包括心肌梗死和脑梗死在内的动脉粥样硬化性疾病之间存在联系。一个典型的例子是，患有和未患有心内膜炎的败血症患者中风风险大幅增加。然而，近期的对照临床研究表明，某些其他较轻微的细菌感染也是梗死的危险因素。既往发热性呼吸道感染是中青年患者中风的主要危险因素。根据一项对照临床研究，肺炎衣原体和牙齿感染似乎是急性心肌梗死患者的危险因素。有几种可能的机制可以解释所观察到的感染与梗死之间的关联。例如，感染会导致血液高凝状态，从而增加血栓形成的风险。此外，感染对前列腺素和脂质代谢有深远的有害影响。在存在高胆固醇血症的情况下，感染还可能通过诱导血管内皮损伤和炎症，在动脉粥样硬化过程本身中发挥一定作用。然而，到目前为止，几乎没有临床证据表明，除了心内膜炎患者外，通过控制感染可以降低梗死风险或动脉粥样硬化病变的发生风险。在心内膜炎患者中，当用抗菌疗法控制感染时，血栓栓塞并发症的风险会迅速降低。
