感染负荷与粥样硬化形成及斑块性质的相关性

Relationship between infection burden and atherosclerosis and plaque feature

目的探讨感染负荷与冠状动脉粥样硬化及其斑块性质的相关性.方法 2001年12月至2003年10月在本院接受介入检查的患者182例,血管内超声检测确定冠状动脉粥样硬化及其斑块性质;介入检查前抽静脉血,酶联免疫吸附检测法(ELISA)检测患者血清巨细胞病毒、幽门螺旋菌、肺炎衣原体、EB病毒、B型柯萨奇病毒、A型流感病毒、B型流感病毒、结核杆菌抗体IgG/IgA及乙肝病毒表面抗原.免疫散射比浊法检测高敏C反应蛋白(hs-CRP)水平.结果根据感染负荷将患者分为三组:A组:感染原n≤3种,B组:n=4～5种和C组:n≥6种.冠状动脉粥样硬化的检出率随感染负荷的增加而增加,各组冠状动脉粥样硬化阳性率分别为44.4%,70.6%和76.7%(P<0.001);感染负荷与动脉粥样硬化阳性率呈正相关,r=0.9396.血清hs-CRP水平升高者(>5.0 mg/L)冠状动脉粥样硬化阳性率升高更明显(43.8%, 70.0%, 70.8%)比(45.5%, 63.7%, 96.8%).A、B、C组易损斑块检出率分别为33.3%、32.4%、51.7%(P<0.05),感染原在5种以上者易损斑块检出率明显升高.结论以往感染微生物数量与冠状动脉粥样硬化率相关,血清hs-CRP水平升高者中两者的相关性更明显, 提示二者有协同作用.高水平的感染负荷与冠状动脉粥样硬化的易损斑块率相关.

Objective To evaluate the relationship between infection burden and coronary atherosclerosis and the plaque feature. Methods One hundred and eighty two patients underwent coronary angiography in Zhongshan Hospital from 2002-2003. Atherosclerosis and vulnerable plaque were determined by intravascular ultrasound (IVUS). Seropositivity of cytomegalovirus, helicobacter pylori, chlamydia pneumonia, hepatitis B virus, EB virus, CoxB virus, influenza A virus, influenza B virus and mycobacterium tuberculosis were determined by ELISA. The serum hs-CRP was detected by Dade Behring prospect ( Immuno-nehelomitery). Patients were divided into three groups according to the pathogen burden: group A, n≤3,group B, n=4-5 and group C, n≥6. Results The pathogen burden was independent of the C-reactive protein level. Increasing pathogen burden was significantly associated with increasing atherosclerosis risk, the prevalence of atherosclerosis was 44.4%,70.6% and 76.7% in group A, B and C. The risk associated with elevated pathogen burden was much higher when CRP was also elevated(>5.0 mg/L) (43.8%, 70.0%, 70.8%)vs(45.5%, 63.7%, 96.8%). The positively of vulnerable plaque increased significantly when the pathogen burden was high(n>5)(33.3%, 32.4% and 51.7% P<0.05). Conclusion Our data suggested that infection burden was associated with prevalence of coronary atherosclerosis,and it was particularly important when C-reactive protein was elevated. The high level infection burden could predict vulnerable plaque.