肺炎衣原体和巨细胞病毒感染与颈动脉粥样硬化斑块及其稳定性的相关性

Correlalions between chlamydophila pneumoniae, cytomegalovirus infection and carotid atherosclerotic plaque and its stability

目的探讨颈动脉粥样硬化的发生与肺炎衣原体（Chlamydiapneumonia，Cpn）和巨细胞病毒（cytomegalovirus，CMV）两种微生物感染的相关性。方法纳入颈动脉彩超显示内膜一中膜厚度（intima．mediathickness，IMT）〉1．5mm的患者作为颈动脉粥样硬化组，而IMT〈1．0mm的健康体检者作为对照组。采用酶联免疫吸附法检测血清抗Cpn和抗CMVIgG抗体水平和阳性率。比较颈动脉粥样硬化组与对照组的人口统计学、血管危险因素以及抗Cpn和抗CMVIgG抗体阳性率。结果颈动脉粥样硬化组共纳入患者92例，其中稳定斑块患者30例，不稳定斑块患者62例；对照组共纳入49例健康体检者。颈动脉粥样硬化组年龄以及男性、高血压、糖尿病、高脂血症和吸烟患者的构成比与对照组均无显著性差异（P均〉0．05）。颈动脉粥样硬化组抗CpnIgG（69．5％对26．5％；疋2=23．887，P〈0．001）、抗CMVIgG（75．O％对30．6％；X2=26．156，P〈0．001）阳性率以及抗CpnIgG＋抗CMVIgG阳性率（51．2％对10．2％∥=24．006，P〈0．001）均显著性高于对照组。在颈动脉粥样硬化组中，不稳定斑块亚组年龄以及男性、高血压、糖尿病、高脂血症和吸烟患者的构成比与稳定斑块亚组均无显著性差异（P均〉0．05）。不稳定斑块亚组抗CpnIgG（80．6％对46．7％；X2=11．025，P=0．001）和抗CMVIgG（83．9％对56．7％髟=7．980，P=0．005）阳性率以及抗CpnIgG＋抗CMVIgG阳性率（44．6％对7．6％；X2=10．210，P=0．006）显著性高于稳定斑块亚组。结论颈动脉粥样硬化的发生和斑块稳定性均与Cpn和CMV感染相关，Cpn和CMV感染可能是颈动脉粥样硬化发生和斑块不稳定的重要因素。

Objective To investigate the correlations between the occurrence of carotid artery atherosclerosis and chlamydia pneumoniae （Cpn） and cytomegalovirus （CMV）. Methods Carotid color ultrasonography showed that the patients with intima-media thickness （IMT） 〉 1.5 mm were enrolled and were used as a carotid atherosclerosis group, and the healthy subjects （IMT 〈 1.0 mm） were used as a control group. Enzyme-linked immunosorbent assay （ELISA） was used to detect the antibody levels and positive rates of the serum anti-Cpn and anti-CMV IgG. The demography, vascular risk factors, anti-Cpn and anti-CMV IgG antibody positive rates of the carotid atherosclerosis group and the control group were compared. Results A total of 92 patients of the carotid atherosclerosis group were enrolled, including 30 patients with stable plaque and 62 with unstable plaque; a total of 49 healthy subjects of the control group were enrolled. There were no significant differences in the proportions of age, male, hypertension, diabetes, hyperlipidemia, and smoking patients between the carotid atherosclerosis group and the control group （all P 〉0. 05）. The anti-Cpn IgG （69. 5% vs. 26. 5% ; x2 = 23. 887, P 〈 0. 001 ）, anti-CMV IgG positive rate （75.0% vs. 30. 6%;X2= 26. 156, P 〈 0. 001）, and anti-Cpn IgG ＋ anti-CMV positive rate （51.2%vs. 10. 2% ;X2 =24. 006, P 〈0. 001） of the carotid atherosclerosis group were significantly higher than those of the control group. In the atherosclerosis group, there were no significant difference in the proportions of age, male, hypertension, diabetes, hyperlipidemia, and smoking patients between the unstable plaque subgroup and the stable plaque subgroup （all P〉 0. 05）. The anti-Cpn IgG （80. 6% vs. 46. 7%; X2 = 11. 025, P=0. 001）, anti-CMV IgG positive rate （83.9% vs. 56. 7%;x2 =7. 980, P=0. 005） and anti-Cpn IgG ＋ anti-CMV positive IgG rate （44. 6% vs. 7. 6% ; x2 = 10. 210, P = 0. 006） of the unstable plaque subgroup were significantly higher than those of stable plaque subgroup. Conclusions The occurrence of carotid atherosclerosis and the stability of plaque are associated with the Cpn and CMV infection. The Cpn and CMV infection may be the important factors for the occurrence of carotid atherosclerosis plaques and unstable plaques.