Gupta S, Camm A J
Department of Cardiological Sciences, St George's Hospital Medical School, London, England.
Drugs Aging. 1998 Jul;13(1):1-7. doi: 10.2165/00002512-199813010-00001.
Conventional cardiovascular risk factors fail to completely explain the observed variations in the prevalence and severity of coronary heart disease (CHD). Common chronic infections may have an aetiological role in the development of atherosclerosis and CHD, either independently or by interacting with traditional atherogenic risk factors. The evidence for Chlamydia pneumoniae as a potential causative agent is strongest, and is based on findings of numerous sero-epidemiological studies, examination of atheromatous plaque specimens, in vitro animal models and, recently, pilot antichlamydial antibiotic intervention trials. However, the complete natural history of C. pneumoniae, its mechanisms of damage in atherosclerotic disease, and the temporal sequence of infection and CHD remain unclear. Confirmation of true causality for the link between C. pneumoniae and CHD could come after the results of large-scale prospective antibiotic trials, which are to be conducted over the next few years. A proven association could have important implications for public health worldwide, potentially leading to novel and relatively inexpensive therapeutic measures in the secondary prevention of CHD--broad-spectrum antibiotics.
传统的心血管危险因素无法完全解释观察到的冠心病（CHD）患病率和严重程度的差异。常见的慢性感染可能在动脉粥样硬化和冠心病的发生过程中发挥病因学作用，其作用方式可能是独立的，也可能是通过与传统的致动脉粥样硬化危险因素相互作用。肺炎衣原体作为潜在病原体的证据最为充分，这一证据基于众多血清流行病学研究的结果、动脉粥样斑块标本检查、体外动物模型以及最近的抗衣原体抗生素干预试验。然而，肺炎衣原体的完整自然史、其在动脉粥样硬化疾病中的损伤机制以及感染与冠心病的时间顺序仍不明确。肺炎衣原体与冠心病之间联系的真正因果关系的确证可能要等到未来几年进行的大规模前瞻性抗生素试验的结果出来之后。一种已被证实的关联可能会对全球公共卫生产生重要影响，有可能在冠心病二级预防中带来新的且相对廉价的治疗措施——广谱抗生素。
