细胞毒素相关基因蛋白A抗体阳性Hp感染对急性心肌梗死患者发病影响的研究

Study on the effect of cytotoxin associated gene protein A antibody positive Hp infection on the incidence of acute myocardial infarction

目的探讨细胞毒素相关基因蛋白A(CagA)抗体阳性幽门螺杆菌(Hp)感染对急性心肌梗死(Acute myocardial infarction,AMI)患者发病影响。方法选择2016年2月至2018年2月本院收治的AMI患者134例作为研究对象,根据冠状动脉造影结果将患者分为AMI组(n=82)和非AMI组(n=52)。采集患者血液并检测低密度脂蛋白胆固醇(LDL-C)、高密度脂蛋白胆固醇(HDL-C)、C反应蛋白(CRP)、同型半胱氨酸(Hcy)等血清项目,收集患者Hp细胞毒素相关基因蛋白A(CagA)抗体、尿素酶A亚单位抗体、尿素酶B亚单位抗体、重组细胞空泡毒素抗原抗体数据,并按照不同分组类别对比各组AMI发病率。有统计学意义的因素进行多因素Logistic回归分析。结果两组患者年龄、糖尿病史、AMI家族史对比差异无统计学意义(P>0.05),男性占比、高血压史、长期吸烟史对比差异有统计学意义(P<0.05)。AMI组和非AMI组LDL-C、Hcy指标水平对比差异无统计学意义(P>0.05),AMI组HDL-C指标水平为(1.10±0.11)mmol/L,低于非AMI组(3.67±0.46)mmol/L,CRP指标水平为(89.16±20.34)mg/L,高于非AMI组(3.24±0.36)mg/L,差异有统计学意义(P<0.05)。本次研究共检测出88例患者发生Hp感染,感染率为65.67%;根据Hp感染分组,Hp阳性组AMI发病率为64.29%,高于Hp阴性组18.75%;Hp阳性患者中CagA抗体阳性组AMI发病率为75.86%,高于CagA抗体阴性组AMI发病率48.15%,差异有统计学意义(P<0.05)。多因素Logistic分析结果显示,CagA抗体阳性、长期吸烟史是造成AMI发病的独立危险因素(P<0.05)。结论 AMI患者HDL-C及CRP水平变化较非AMI患者明显,CagA抗体Hp感染与AMI发病密切相关,且CagA抗体阳性、长期吸烟史是造成AMI发病的独立危险因素,CagA抗体阳性可以作为预测AMI发病的有效指标。

Objective To explore the effect of Helicobacter pylori(Hp) infection caused by antibody to A(CagA), a cytotoxin associated gene protein, on the incidence of acute myocardial infarction(AMI). Methods A clinical data of 134 patients who were hospitalized in our hospital from February 2016 to February 2018 with AMI were chosen as objects. According to the results of coronary angiography, the patients were divided into AMI group(n=82) and non-AMI group(n=52). Blood was collected and serum items such as low-density lipoprotein cholesterol(LDL-C), high-density lipoprotein cholesterol(HDL-C), C-reactive protein(CRP) and homocysteine(Hcy) were detected. The Hp cytotoxin associated gene protein A(CagA) antibody, the urease A subunit antibody, and the urease B subunit antibody were collected. The cell vacuolar toxin antigen antibody data were reorganized and the incidence of AMI in each group was compared according to different grouping categories. Multivariate Logistic regression analysis was conducted for statistical significance. Results There was no statistical difference between the two groups of age, diabetes history and AMI family history(P>0.05). The comparison of male occupation, hypertension and long-term smoking history was statistically significant(P<0.05). There was no statistical difference in the level of LDL-C and Hcy in AMI group and non-AMI group(P>0.05), and the level of HDL-C index in AMI group in AMI group was(1.10 ± 0.11)mmol/L, significantly lower than that of non-AMI group(3.67 ± 0.46)mmol/L, CRP index level in AMI group was(89.16 ± 20.34) mg/L, which was significantly higher than that in non-AMI group(3.24 ± 0.36)mg/L, and the data comparison was statistically significant(P<0.05). A total of 88 cases of Hp infection were detected in this study, the infection rate was 65.67%. According to the Hp infection group, the incidence rate of AMI in Hp positive group was 64.29%, significantly higher than that of Hp negative group 18.75%. The AMI incidence rate of CagA antibody positive group in Hp positive group was 75.86%, which was significantly higher than that of CagA antibody negative group 48.15%, and the data comparison was statistically significant(P<0.05). Multivariate Logistic analysis showed that CagA antibody positive and long-term smoking were independent risk factors for AMI(P<0.05). Conclusion The changes of HDL-C and CRP levels in AMI patients are more obvious than those of non-AMI patients. CagA antibody Hp infection is closely related to the pathogenesis of AMI, and CagA antibody positive and long-term smoking history are independent risk factors for AMI. CagA antibody positive could be used as an effective indicator of AMI disease prediction.