【作者】 于海杰；

【导师】 齐国先；

【作者基本信息】 中国医科大学 ， 内科学， 2004， 硕士

【摘要】 前言 传统观点认为，血脂异常、高血压、糖尿病、吸烟、性别、年龄因素和心脑血管病早发家族史等是引起动脉粥样硬化(Atherosclerosis，AS)及其相关疾病特别是冠状动脉粥样硬化性心脏病(Coronary artery disease，CAD)的独立危险因素，并在冠心病的防治实践中得以证实。然而，有大约50％的动脉粥样硬化的病人缺乏已确立的危险因素，这使人们不得不继续寻找新的动脉粥样硬化危险因素。越来越多的资料暗示感染物质在动脉粥样硬化的发生中起一定作用，而血管壁损伤的炎症反应是动脉粥样硬化的主要原因之一。肺炎衣原体是其中研究热点之一。但仍有一些学者存在不同的结论和解释，以及肺炎衣原体感染是否为冠心病的独立危险因素及其作用机制，目前也无定论。 目的 本研究通过检测30例急性心肌梗死(Acute myocardial infarction，AMI)病人和30名健康对照者血清中肺炎衣原体特异抗体滴度，以及血脂(TG，TC，LDL-C，HDL-C)、空腹血糖(FBG)等相关因素，旨在从血清流行病学探讨肺炎衣原体感染与急性心肌梗死和动脉粥样硬化的相关性及可能作用机制。 方法 选择2003年2月至2004年3月期间门急诊和心内科住院过程中检出的急性心肌梗死30人以及同期健康体检者30人，采用间接微量免疫荧光法(micro-IF，MIF)检测肺炎衣原体特异性IgG、IgM抗体，同时在本院化验室测定空腹血脂、血糖值。结果 1.在所有60例对象中，43名(71 .67%)为男性，17名(28.33%)为女性，年龄为38一83岁，平均年龄58.42士10.%岁。急性心肌梗死组与对照组的一般临床资料对比，在年龄、性别比、吸烟率、BMI水平及高血压和糖尿病患病率等方面差异均无显著性意义(p>0.05);血脂水平除HDL一c外，TG、TC和LDL一C水平急性心肌梗死组均高于对照组，差异均有.显著性意义(p<0.05)，HDL一C水平低于对照组但无显著性差异(p>0.05)。除血脂外，一般情况相似，具有可比性。 2.急性心肌梗死组与对照组的肺炎衣原体特异性IgG抗体在<1:16，1:16，1:64，1:256和1:5 12各水平的检出数分别为7(23 .3%)，8(!26 .7%)，10(33.4%)，4(13.3%)，1(3.3%)与20(66.7%)，5(16.7%)，4(13.3%)，1(3 .3%)，O(O%);两组肺炎衣原体特异性 IgM抗体检测阳性后加做类风湿因子试验(乳胶凝集法)，结果均为阴性。根据诊断标准，急性心肌梗死组和对照组肺炎衣原体慢性感染率分别为73 .33%和33 .33%，有显著性差异(p<0.05);急性心肌梗死组有1人为急性感染(感染率为3.3%)，而对照组无急性感染者，两组比较无显著性差异(p>0 .05)。 3.将本组资料根据肺炎衣原体慢性感染情况分为肺炎衣原体慢性感染阳性组和阴性组，阳性组TG、TC和LDL一C水平高于阴性组，并有显著性差异(p<0.05);阳性组HDL一C水平低于阴性组但无显著性差异(p>0 .05);阳性组FBG水平也高于阴性组，但无显著性差异(p>0.05)。结论1.急性心肌梗死病人中肺炎衣原体慢性感染率较高;肺炎衣原体慢性感染可能是动脉粥样硬化病变的危险因素。2.肺炎衣原体慢性感染病人中血脂异常病人明显增多;肺炎衣原体感染引起动脉粥样硬化病变的可能机制是导致血脂异常。更多还原

【Abstract】 The established independent risk factors for atherosclerosis ( AS) and corre-lating diseases, especially coronary artery disease (CAD) include dyslipidemia, hypertension, diabetes , smoking, gender, age and family history have been widespread admitted in the practice of prevention and cure to CAD. However, they do not completely explain the pathogenesis of the diseases and people have to search for additional risk factors for diseases. More and more data suggest that the potential role of infection develop atherosclerosis and the injury of vassal dissepiment is one of main cause of atherosclerosis. Chlamydia pneumoniae ( CP) is one of the hot spot in the studies. But there are some opposite conclusions and interpretations in the studies and investigators have not gained accepted conclusions in the mechanisms of the association between infection with CP and AS.ObjectiveThe present study measured 30 acute myocardial infarction ( AMI) patients and 30 controls specific CP IgG, IgM antibody and triglycerides ( TG) , total cholesterol(TC) , low - density lipoprotein cholesterol ( LDL - C) , high - density lipoprotein cholesterol (HDL-C) , fasting blood glucose (FBG) to evaluate the association between prior infection with CP and AMI, the mechanisms of this association as well as.MethodsTwo groups of patients were investigated between Feb, 2003 and Mar ,2004 at clinic and emergency in hospital. The AMI group consisted of 30 people admitted because of an acute myocardial infarction and the control group were 30 people without known coronary artery disease. A micro - immunofluorescent as-say(MIF) was used to measure specific CP IgG, IgM antibody. Meanwhile the serum lipids and FBG were performed in the laboratory of hospital.Result1. There were 43 men(71.67%) and 17 women(28. 33% ) in all cases, mean age 58.42 10.96, range 38-83. The generally clinical data, including age, gender, smoking, body mass index(BMI) , and prevalence rate of hyper-tension and diabetes, were no difference occurred in the two groups (p >0. 05). Compare with control group, the levels of TG, TC and LDL- C in AMI group were significantly higher( p <0.05). HDL - C was lower than in AMI group, but there was no statistical significance (p >0.05). Apart from the serum lipid, the generally clinical data of two groups were comparability.2. The number of checking out specific CP IgG antibody from different levels of < 1:16, 1:16, 1:64, 1:256 and 1:512 separately were 7(23. 3% ) , 8 (26.7% ) , 10(33.4% ) , 4( 13. 3% ) , 1(3. 3% ) . After the samples were indicated specific CP IgM antibody positivity, we assayed them rheunuitoid factor (RF) using latex agglutination test and all the results were negativity. According to the standard of diagnosis, the CP prior infection rate of AMI group was higher than that of control group (73.33% Vs 33. 33% , p <0. 05). 1 patient was diagnosed as CP acute infection in AMI group, while no one in control group. The difference was no statistical significance (p >0.05).3. All the cases were divided into positive group of CP prior infection and negative group of CP prior infection. The levels of TG,TC and LDL - C in positive group were significantly higher than negative group( p <0. 05). In positive group HDL - C was lower and FBG was higher than in negative group ;but the differences were no statistical significance (p >0.05).Conclusion1. The CP prior infection rate of AMI group was significandy higher; so CP prior infection maybe one of the risk factors of AS.2. The levels of dyslipidemia in positive patients of CP prior infection were significandy higher; so the mechanisms of the association between CP prior infection and AS maybe dyslipidemia.更多还原