常见社区感染与冠状动脉疾病及急性心肌梗死风险：肿瘤坏死因子α和血管细胞黏附分子-1慢性过度表达的证据

Common community infections and the risk for coronary artery disease and acute myocardial infarction: evidence for chronic over-expression of tumor necrosis factor alpha and vascular cells adhesion molecule-1.

作者信息

Nikolopoulou Aggeliki, Tousoulis Dimitris, Antoniades Charalambos, Petroheilou Katerina, Vasiliadou Carmen, Papageorgiou Nikos, Koniari Katerina, Stefanadi Elli, Latsios George, Siasos Gerasimos, Stefanadis Christodoulos

机构信息

Cardiology Department, Hippokration Hospital, Athens University Medical School, Athens, Greece.

出版信息

Int J Cardiol. 2008 Nov 12;130(2):246-50. doi: 10.1016/j.ijcard.2007.08.052. Epub 2007 Dec 11.

DOI:10.1016/j.ijcard.2007.08.052

PMID:18063147

Abstract

BACKGROUND

Although several common community infections have been associated with the risk for coronary artery disease (CAD), their role in the development of acute myocardial infarction (AMI) is still unclear. We examined the prevalence of IgG and IgM (or IgA) antibodies against common infections such as HSV, Hepatitis A (HAV), Helicobacter pylori (HP), cytomegalovirus (CMV) and Chlamydia pneumoniae (CP), in CAD and AMI patients, and their relationship with pro-atherogenic inflammatory molecules.

METHODS

A total number of 337 subjects were included in this study: 150 patients with angiographically documented stable CAD, 138 patients admitted with AMI and 49 healthy individuals. Serum IgG and IgM against HAV, CMV and HSV, IgG against HP and IgG/IgA against CP were determined in all participants. Serum tumor necrosis factor alpha (TNF-alpha) and soluble vascular cells adhesion molecule (sVCAM-1), were determined by ELISA.

RESULTS

Patients with CAD were more likely to have anti-HAV IgG (94.4%), anti-HSV IgG (97.2%) and anti-HP IgG (55.1%) compared to healthy individuals (70.8%, 89.6% and 39.6% respectively, p<0.05 for all). In multivariate analysis, anti-HAV IgG was an independent predictor of CAD (beta(SE): 0.187(0.075), p=0.015). Among the CAD patients, the presence of anti-CP IgA was more frequent in those admitted with AMI (39%) compared to those with stable CAD (21%, p<0.05). Finally, both patients and controls had significantly higher levels of sVCAM-1 and TNF-alpha in the presence of anti-HAV IgG, compared to those without anti-HAV IgG (p<0.05 for all).

CONCLUSION

Past infections with HAV, HSV and HP are associated with higher risk for coronary atherosclerosis, while the presence of anti-HAV IgG is also associated with higher levels of TNF-alpha and sVCAM-1. Furthermore, the presence of recent infection by CP is associated with higher risk for AMI among CAD patients. These findings are important since they demonstrate that past HAV, HSV and HP infections may affect cardiovascular risk, while recent CP infection may be implicated in the triggering of AMI among CAD patients.

摘要

背景

尽管几种常见的社区感染与冠状动脉疾病（CAD）风险相关，但其在急性心肌梗死（AMI）发生发展中的作用仍不明确。我们检测了CAD和AMI患者中针对常见感染（如单纯疱疹病毒（HSV）、甲型肝炎病毒（HAV）、幽门螺杆菌（HP）、巨细胞病毒（CMV）和肺炎衣原体（CP））的IgG和IgM（或IgA）抗体的流行情况，以及它们与促动脉粥样硬化炎症分子的关系。

方法

本研究共纳入337名受试者：150例经血管造影证实为稳定型CAD的患者、138例因AMI入院的患者和49名健康个体。测定了所有参与者针对HAV、CMV和HSV的血清IgG和IgM、针对HP的IgG以及针对CP的IgG/IgA。通过酶联免疫吸附测定法（ELISA）测定血清肿瘤坏死因子α（TNF-α）和可溶性血管细胞粘附分子（sVCAM-1）。

结果

与健康个体相比，CAD患者更易出现抗HAV IgG（94.4%）、抗HSV IgG（97.2%）和抗HP IgG（55.1%）（健康个体分别为70.8%、89.6%和39.6%，所有p<0.05）。多因素分析中，抗HAV IgG是CAD的独立预测因子（β（标准误）：0.187（0.075），p = 0.015）。在CAD患者中，因AMI入院者抗CP IgA的出现频率（39%）高于稳定型CAD患者（21%，p<0.05）。最后，与无抗HAV IgG者相比（所有p<0.05），有抗HAV IgG时患者和对照组的sVCAM-1和TNF-α水平均显著更高。

结论

既往感染HAV、HSV和HP与冠状动脉粥样硬化风险增加相关，而抗HAV IgG的存在也与TNF-α和sVCAM-1水平升高相关。此外，CAD患者近期感染CP与AMI风险增加相关。这些发现很重要，因为它们表明既往HAV, HSV和HP感染可能影响心血管风险，而近期CP感染可能与CAD患者中AMI的触发有关。