Strachan D P, Mendall M A, Carrington D, Butland B K, Yarnell J W, Sweetnam P M, Elwood P C
Department of Public Health Sciences, St George's Hospital Medical School, Cranmer Terrace, London, UK.
Circulation. 1998 Sep 29;98(13):1286-90. doi: 10.1161/01.cir.98.13.1286.
Associations have been suggested between Helicobacter pylori seropositivity, cardiovascular risk factors, and ischemic heart disease (IHD). The effect of this common infection on mortality is uncertain.
Plasma specimens collected during 1979 to 1983 from 1796 men in Caerphilly, South Wales, were analyzed for IgG antibodies to H pylori. Cause of death and occurrence of incident IHD events were ascertained over an average of 13.7 years from death certificates, hospital records, and ECG changes at 5-yearly follow-up examinations. Seventy percent of men were seropositive. The prevalence of IHD at entry was similar in men with and without H pylori antibodies (odds ratio [OR], 1.10; 95% CI, 0.87 to 1.40). Seropositivity was significantly (P<0.05) associated with poorer socioeconomic status currently and in childhood, shorter stature, and poorer ventilatory function at entry but not with age, smoking, body mass index, blood pressure, total cholesterol, HDL cholesterol, LDL cholesterol, fibrinogen, plasma viscosity, or heat shock protein antibodies. Thirteen-year incidence of IHD was not significantly associated with H pylori (OR, 1.05; 95% CI, 0.80 to 1.39), but there was a stronger relationship with all-cause mortality (OR, 1.46; 95% CI, 1.12 to 1.92) and fatal IHD (OR, 1.54; 95% CI, 1.03 to 2.30). After adjustment for cardiovascular risk factors and both adult and childhood socioeconomic status, ORs were slightly reduced and lost statistical significance (OR=1.32 [95% CI, 0.99 to 1.78] for all-cause mortality and OR=1.52 [95% CI, 0.99 to 2.34] for fatal IHD).
H pylori infection is unlikely to be as strong a risk factor for IHD as some previous studies have suggested, but its relationship to mortality, including fatal IHD, deserves further investigation. The mechanism underlying these associations is unlikely to involve hypertension, circulating lipid profile, fibrinogen, or cross-reacting antibodies to bacterial heat shock proteins.
幽门螺杆菌血清阳性与心血管危险因素及缺血性心脏病（IHD）之间可能存在关联。这种常见感染对死亡率的影响尚不确定。
对1979年至1983年期间从南威尔士卡菲利的1796名男性中采集的血浆标本进行分析，检测幽门螺杆菌IgG抗体。通过死亡证明、医院记录以及每5年一次随访检查时的心电图变化，平均在13.7年的时间里确定死亡原因和IHD事件的发生情况。70%的男性血清呈阳性。在有和没有幽门螺杆菌抗体的男性中，入组时IHD的患病率相似（优势比[OR]为1.10；95%可信区间为0.87至1.40）。血清阳性与当前及儿童时期较差的社会经济地位、较矮的身高以及入组时较差的通气功能显著相关（P<0.05），但与年龄、吸烟、体重指数、血压、总胆固醇、高密度脂蛋白胆固醇、低密度脂蛋白胆固醇、纤维蛋白原、血浆粘度或热休克蛋白抗体无关。IHD的13年发病率与幽门螺杆菌无显著关联（OR为1.05；95%可信区间为0.80至1.39），但与全因死亡率（OR为1.46；95%可信区间为1.12至1.92）和致命性IHD（OR为1.54；95%可信区间为1.03至2.30）的关系更强。在对心血管危险因素以及成人和儿童社会经济地位进行调整后，优势比略有降低且失去统计学意义（全因死亡率的OR = 1.32 [95%可信区间为0.99至1.78]，致命性IHD的OR = 1.52 [95%可信区间为0.99至2.34]）。
幽门螺杆菌感染不太可能像一些先前研究表明的那样是IHD的强危险因素，但其与包括致命性IHD在内的死亡率之间的关系值得进一步研究。这些关联背后的机制不太可能涉及高血压、循环血脂谱、纤维蛋白原或针对细菌热休克蛋白的交叉反应抗体。
