Elkind Mitchell S V
Neurological Institute, 710 West 168th Street, Box 182, New York, NY 10032, USA.
Infect Disord Drug Targets. 2010 Apr;10(2):84-90. doi: 10.2174/187152610790963519.
Atherosclerosis is a chronic inflammatory process, and several common bacterial and viral infections have been hypothesized to contribute to the inflammation of the vascular wall that leads to atherosclerosis. More recently, investigators have found preliminary evidence that the aggregate burden of these chronic infections, rather than any single organism, may contribute to atherosclerosis and risk of clinical vascular events, including ischemic stroke. This aggregate burden of infections, which has been variably labeled "infectious burden" or "pathogen burden," may be associated with stroke through mechanisms independent of atherosclerosis, as well, including platelet aggregation and endothelial dysfunction. Host factors, moreover, may interact with infectious burden to modify the risk of disease associated with these infections. Currently there is no commonly accepted group of organisms or method of assessing infectious burden, and not all studies confirm an association of infection and stroke risk. Nonetheless, if infectious burden does play a role in atherosclerosis or stroke, it is plausible that preventive anti-infective treatment, such as vaccination, or antibiotics, would reduce the risk of incident or recurrent stroke. While influenza vaccination has been recommended to prevent recurrence among those with coronary disease, similar recommendations for stroke patients have not yet been made. Large scale randomized clinical trials of macrolide antibiotics for coronary patients, moreover, have been negative. Further studies are needed, however, to determine whether an association between infectious burden and stroke exists, and whether infectious burden may be a target for intervention.
动脉粥样硬化是一种慢性炎症过程，已有研究推测几种常见的细菌和病毒感染会导致血管壁炎症，进而引发动脉粥样硬化。最近，研究人员发现初步证据表明，这些慢性感染的总负担而非任何单一病原体，可能会导致动脉粥样硬化及临床血管事件的风险增加，包括缺血性中风。这种感染的总负担，被不同地称为“感染负担”或“病原体负担”，也可能通过独立于动脉粥样硬化的机制与中风相关，包括血小板聚集和内皮功能障碍。此外，宿主因素可能与感染负担相互作用，从而改变与这些感染相关的疾病风险。目前，尚无普遍接受的评估感染负担的生物体类别或方法，而且并非所有研究都证实感染与中风风险之间存在关联。尽管如此，如果感染负担确实在动脉粥样硬化或中风中起作用，那么预防性抗感染治疗，如接种疫苗或使用抗生素，有可能降低首次或复发性中风的风险。虽然已建议对冠心病患者接种流感疫苗以预防复发，但尚未对中风患者提出类似建议。此外，针对冠心病患者使用大环内酯类抗生素的大规模随机临床试验结果为阴性。然而，仍需要进一步研究以确定感染负担与中风之间是否存在关联，以及感染负担是否可能成为干预靶点。
