人巨细胞病毒检测在动脉粥样硬化病变中的临床意义研究

Detection of human cytomegalovirus in patients with atherosclerosis and its clinical significance

目的观察人巨细胞病毒（HCMV）在动脉粥样硬化病变中的致病作用，并探讨其相关的临床意义。方法收集2009年12月至2012年4月诊治的动脉粥样硬化患者134例（观察组），其中冠心病（CHD）患者102例，非CHD患者32例，将102例CHD患者根据HCMV检测结果分为HCMV感染组86例和非HCMV感染组16例，另选取健康体检者40例作为对照组。采用多普勒超声检测颈动脉内膜．中层厚度（IMT），酶联免疫吸附试验法检测血清HCMV-IgM。结果观察组HCMV阳性率为77．6％（104／134），显著高于对照组的37．5％（15／40），差异有统计学意义（P〈0．05）。观察组中CHD患者和非CHD患者HCMV阳性率分别为84．3％（86／102）和56．2％（18，32），差异有统计学意义（P〈0．05）。HCMV感染的动脉粥样硬化患者颈动脉IMT为（1．31±0．28）mm，显著高于非HCMV感染的（1．14±0．21）mm，差异有统计学意义（P〈0．05）。HCMV感染组患者心肌梗死和冠状动脉多支病变的发生率分别为39．5％（34／86）、43．0％（37／86），显著高于非HCMV感染组的25．0％（4，16）、18．8％（3／16），差异有统计学意义（P〈0．05），而稳定型心绞痛和冠状动脉单支病变的发生率分别为26．7％（23，86）、22．1％（19，86），显著低于非HCMV感染组的43．8％（7／16）、56．2％（W16），差异有统计学意义（P〈0．05）。结论动脉粥样硬化病变患者中存在HCMV的高感染率，HCMV感染可能参与了动脉粥样硬化病变的发生、发展过程。

Objective To investigate the infection of human cytomegalovirus （HCMV） in patients with atherosclerosis and explore its clinical significance. Methods A total of 134 patients with atherosclerosis （observation group） including 102 patients with coronary heart disease （CHD） and 32 patients with non-CHD from December 2009 to April 2012 were enrolled in this study. The 102 patients with CHD were divided into HCMV infection group （86 cases） and non-HCMV infection group （16 cases）. Another 40 healthy person were selected as control group. The carotid intima-media thickness （IMT） was assessed by ultrasonography. The serum HCMV-IgM was measured by enzyme-linked immunosorbent assay. Results The infection rate of HCMV in observation group was 77.6%（104/134）, which was higher than that of 37.5% （15/40） in control group（P 〈 0.05 ）. The infection rate of HCMV in CHD patients and non-CHD patients was 84.3%（86/102） and 56.2%（18/32）, and there was significant difference （P 〈 0.05）. The carotid IMT in HCMV infected atherosclerosis patients was （ 1.31 ± 0.28） mm, which was higher than that of （ 1.14 ± 0.21 ） mm in non-HCMV infected atherosclerosis patients （P 〈 0.05）. The incidence of myocardial infarction and multi-vessel lesion in HCMV infection group was higher than that in non-HCMV infection group [39.5% （ 34/86 ） vs. 25.0% （4/16） and 43.0% （ 37/86 ） vs. 18.8% （ 3/16 ） ] （P 〈 0.05 ）. The incidence of stable angina pectoris and single-vessel lesion in HCMV infection group was lower than that in non-HCMV infection group [26.7%（23/86） vs. 43.8%（7/16） and 22.1%（19/86） vs. 56.2%（9/16）]（P〈0.05）. Conclusion The high-infection rate of HCMV is found in atherosclerosis patients, and it maybe have a close relationship with the occurrence and development of atherosclerosis.