急性冠脉综合征患者发病前感染发生情况调查

Survey of infection rates in patients with acute coronary syndrome

目的 观察冠心病患者急性发病前感染发生情况及急性冠脉综合征 (ACS)患者C反应蛋白(CRP)水平。方法 2 0 0 1年 10月～ 2 0 0 2年 4月 ,采用病例对照研究的方法 ,共调查上海市 16所二、三级医院心内科住院的稳定型心绞痛 (SAP)、不稳定型心绞痛 (UAP)及急性心肌梗死 (AMI)患者 184 7例 ;将UAP和AMI患者合并为ACS组 (114 3例 ) ,SAP患者作为对照 (SAP组 ,6 4 4例 )。结果 ACS组急性发病前感染发生率(4 2 .4 3% )显著高于SAP组 (2 7.33% ,P <0 .0 1) ;发病前病因谱主要是上呼吸道感染和肺炎 ,大部分ACS患者的感染均发生在急性发病前 2周内 (78.76 % ) ,而SAP患者的感染时间无特殊分布 ;ACS组CRP增高患者的比例(6 1.0 6 % )高于SAP组 (4 2 .35 % ,P =0 .0 0 1) ,ACS组CRP增高者中 5 8.75 %有发病前感染史 ,而CRP正常者中仅 4 0 .98% (P <0 .0 5 )。结论 ACS患者的急性起病与发病前急性感染可能存在相关性 ,而CRP作为炎症标志对ACS的发生有预测价值。

Objective To survey the infection rates before the onset of acute coronary syndrome(ACS) and the C-reactive protein(CRP) levels in patient with coronary heart disease(CHD). Methods Between October 2001 and April 2002, a total of 1 847 patients with stable angina pectoris(SAP), unstable angina pectoris(UAP) or acute myocardial infarction(AMI) were surveyed through case control in 16 hospitals of Shanghai. Results The infection rate of ACS group(1 143 cases) was 42.43%, which was higher than that of SAP group(644 cases, 27.33%, P<0.01). Upper respiratory infection and pneumonia were the mostly encountered, occuring within 2 weeks before onset of angina or AMI in the majority of patients with ACS. There were 61.06% patients in ACS group whose CRP levels were higher than normal, and 42.35% in SAP group(P<0.05). Conclusion The onset of ACS may be related to acute infections diseases. As an inflammatory marker, CRP has predictive value for onset of ACS in patients with CHD.