Gabriel A S, Gnarpe H, Gnarpe J, Hallander H, Nyquist O, Martinsson A
Department of Cardiology, Huddinge University Hospital, Stockholm, Sweden.
Eur Heart J. 1998 Sep;19(9):1321-7. doi: 10.1053/euhj.1998.1010.
Cross-sectional serological studies have suggested an association between ischaemic heart disease and infections from Chlamydia pneumoniae and Helicobacter pylori. We therefore sought to find out if patients with ischaemic heart disease had an increased prevalence of C. pneumoniae in the pharynx. As the course of the C. pneumoniae infection remains unclear, both acute and follow-up samples were taken and compared with antibody levels.
We studied 282 patients with ischaemic heart disease. One hundred and two subjects without history or symptoms of ischaemic heart disease served as controls. Pharyngeal specimens for polymerase chain reaction detection of C. pneumoniae, and blood samples for C. pneumoniae and H. pylori antibody detection, were collected. In patients with positive polymerase chain reaction or C. pneumoniae IgA titres > or = 32, indicating current infection, convalescent samples were taken at least 6 weeks later. An immunofluorescent antigen detection test was used to confirm the presence of C. pneumoniae elementary bodies in specimens found to be polymerase chain reaction positive. The prevalence of positive polymerase chain reaction tests was 36% among patients and 22% among controls (P<0.05). Forty-seven percent of patients with positive polymerase chain reaction remained positive in the convalescent test. Elevated C. pneumoniae IgG titres > or = 512 were found in 39% of patients and 26% of the controls (P<0.05). IgA titres > or = 32 were found in 46% of the patients and 44% of the controls (ns). Antibody titres remained largely unchanged at convalescent testing. Two patients and none of the controls had IgM titres > 16. There was no link between positive H. pylori serology and positive C. pneumoniae polymerase chain reaction tests.
The high prevalence and persistence of positive pharyngeal C. pneumoniae polymerase chain reaction and elevated antibody titres in patients with ischaemic heart disease indicate a chronic infection. The pharyngeal presence of C. pneumoniae might contribute to a low grade inflammatory activation or be a source for further spread of the bacteria to atherosclerotic vessels.
横断面血清学研究提示缺血性心脏病与肺炎衣原体及幽门螺杆菌感染之间存在关联。因此，我们试图查明缺血性心脏病患者咽部肺炎衣原体的患病率是否增加。由于肺炎衣原体感染的病程尚不清楚，我们采集了急性期和随访期样本，并与抗体水平进行比较。
我们研究了282例缺血性心脏病患者。102例无缺血性心脏病病史或症状的受试者作为对照。采集咽部标本用于肺炎衣原体的聚合酶链反应检测，采集血液样本用于肺炎衣原体和幽门螺杆菌抗体检测。对于聚合酶链反应阳性或肺炎衣原体IgA滴度≥32（表明当前感染）的患者，至少在6周后采集恢复期样本。采用免疫荧光抗原检测试验确认聚合酶链反应阳性标本中肺炎衣原体原体的存在。患者中聚合酶链反应检测阳性的患病率为36%，对照组为22%（P<0.05）。聚合酶链反应阳性的患者中有47%在恢复期检测仍为阳性。39%的患者和26%的对照组肺炎衣原体IgG滴度升高≥512（P<0.05）。46%的患者和44%的对照组IgA滴度≥32（无统计学意义）。恢复期检测时抗体滴度基本保持不变。2例患者IgM滴度>16，对照组无此情况。幽门螺杆菌血清学阳性与肺炎衣原体聚合酶链反应检测阳性之间无关联。
缺血性心脏病患者咽部肺炎衣原体聚合酶链反应阳性的高患病率和持续性以及抗体滴度升高表明存在慢性感染。咽部肺炎衣原体的存在可能导致低度炎症激活，或成为细菌向动脉粥样硬化血管进一步传播的来源。
