巨细胞病毒感染与冠心病急性心肌梗死及其患者炎症因子的相关性研究

目的探讨巨细胞病毒(CMV)感染与急性心肌梗死的关系。方法分别采用酶联免疫吸附试验(ELISA)和聚合酶链反应(PCR)技术测定51例急性心肌梗死、42例陈旧性心肌梗死患者及冠脉造影正常的31例正常对照者、33例非冠心病患者血CMV抗体水平及DNA,同时检测各组的超敏C反应蛋白(hsCRP)、可溶性细胞间黏附分子1(sICAM-1)、白细胞介素6(IL-6)变化。结果急性心肌梗死组(治疗前)CMV IgG,CMV IgM阳性率及水平显著高于正常对照组、非冠心病组(均P<0.01),CMV DNA检测结果与之吻合。校正冠心病危险因素前后,CMV IgG阳性均与急性心肌梗死有相关性(分别:OR=3.262,P=0.021;OR=3.047,P=0.030)。急性心肌梗死组治疗前hsCRP,sICAM-1,IL-6均显著高于其他各组(均P<0.01);急性心肌梗死组中CMV IgG( )组与同组CMV IgG(-)组比较,hsCRP,sICAM-1,IL-6均显著升高(P<0.01);IgG水平与hsCRP,sICAM-1,IL-6呈正相关。结论急性或激活性CMV感染与急性心肌梗死的发生有关,CMV感染可能通过激发和加重冠状动脉内炎症反应,参与动脉粥样硬化、急性心肌梗死的病理过程。     

冠心病与炎症和免疫系统关系的临床研究

目的 探讨炎症和机体免疫反应与冠心病（CHD）之间的相关性。方法 设立病例组与正常对照组，病例组选取经冠状动脉造影证实为CHD的患者80例，包括心肌梗死（AMI）组26例，不稳定型心绞痛（UP）组24例，稳定型心绞痛（SP）组30例；正常对照组为30例体检健康者。分别测定所有研究者的血清C-反应蛋白（CRP）、IgG、IgA、IgM等指标。结果 AMI组和UP组的CRP、IgG、IgA水平与对照组比较，差异有统计学意义（P〈0．05或P〈0．01）；AMI组、UP组和SP组的IgM水平，SP组的CRP、IgG水平与对照组比较，差异均无统计学意义（P〉0．05）。结论 CHD与炎症和机体免疫系统的激活密切相关。     

CP和HP感染及hs-CRP检测与冠心病关系的临床观察

本文探讨肺炎衣原体(CP)及幽门螺杆菌(HP)感染、炎症标记物c反应蛋白(CRP)与冠心病(CHD)间的相互关系。作者测定50例冠心病患者、4l例冠脉造影正常的疾病对照组患者和44例正常对照者血清CPIgG和IgM及HP IgG和IgM，同时测定上述人群血清超敏CRP(hs-CRP)含量。结果表明，CP和SP感染及超敏CRP含量与CHD的发病有密切关系。     

幽门螺杆菌感染对冠心病患者血清指标的影响

目的探讨幽门螺杆菌(Hp)感染对冠心病患者血清生化水平的影响,观察Hp感染和冠心病之间的关系,以期为临床诊治冠心病患者Hp感染提供参考。方法随机选取2011年12月-2013年1月150例经冠状动脉造影确定为冠心病患者(试验组)为研究对象,另外选取150例排除冠心病的患者(对照组)进行比较,观察两组在血生化指标、血清Hp IgG、血清同型半胱氨酸(HCY)和血清高敏C-反应蛋白(HCRP)的浓度。结果试验组高密度脂蛋白(HDL)、甘油三酯(TG)和总胆固醇(TC)浓度分别为(0.93±0.11)、(1.34±0.24)、(4.42±0.16)mmol/L,对照组为(0.99±0.15)、(1.12±0.14)、(4.02±0.18)mmol/L,两组比较差异有统计学意义(P<0.05);对照组的血清Hp IgG阳性为33.3%,试验组为80.7%,差异有统计学意义(P<0.05);而试验组Hp IgG阳性与阴性患者在低密度脂蛋白(LDL)、HDL、TG、HCY、CRP和Gensini评分,差异均有统计学意义(P<0.05)。结论 Hp感染患者可通过增加HCY和HCRP水平来影响正常的脂类的代谢,进而影响冠心病的发生和发展。     

肝硬化医院感染患者C反应蛋白、白细胞介素6检测意义

目的 了解C反应蛋白(CRP)、白细胞介素—6(IL—6)在肝硬化医院感染患者的变化。方法 对肝硬化医院感染43例患者的CRP、IL-6的活性进行检测，并设置同期对照组43例。结果 感染组CRP阳性率明显高于对照组(P＜0．05)；感染组IL--6明显高于对照组(P＜0．01)。结论 肝硬化医院感染患者炎症标记物明显升高，对肝硬化患者发生医院感染有明显的监测作用。     

血清C反应蛋白与冠心病严重程度关系的研究

目的探讨血清C反应蛋白(CRP)与冠脉病变严重程度及稳定性的关系。方法选择性冠状动脉造影患者193例,冠脉造影阴性者61例设为对照组,冠心病(CHD)组132例,比较各组CRP间的差异;分析冠心病组病变严重程度与CRP水平的关系。结果CHD组CRP高于对照组(p<0·01);ACS组明显高于SAP组(p<0·01)和对照组(p<0·001),而SAP组与对照组之间比较差异不显著(p>0·05);CHD组血清CRP与GS显著相关(r=0·34,p<0·001),相关关系独立于年龄、TC/HDL-C、BMI和吸烟等因素以外;多元逐步回归分析表明,CHD组血清CRP和TC/HDL-C比值对GS有显著影响(均p<0·001)。结论C反应蛋白是CHD发病重要的预测因子,与冠脉病变严重程度、粥样斑块的稳定性密切相关。     

Barrett食管与幽门螺杆菌感染关系的研究

目的　探讨Barrett食管 (BE)与幽门螺杆菌 (Hp)感染的关系。方法　经胃镜及组织学检查 ,选取BE患者 3 2例作为研究组 ,单纯反流性食管炎 (RE)及正常人各 3 0例作为对照组 ,比较组间Hp感染情况及前两组Hp感染与炎症分级间的关系。结果　在食管部位 ,Hp阳性率研究组明显高于两对照组 (P <0 .0 1) ;在胃窦部 ,Hp阳性率无组间差异 (P >0 .0 5)。在BE组 ,Hp阳性率中、重度炎症均高于轻度炎症 (P <0 .0 5)。在RE组 ,Hp阳性率在轻、中、重度炎症间无差异 (P >0 .0 5)。结论　Hp感染是引起BE的重要原因之一并可能与其炎症轻重相关 ,而且Hp可能并不依赖于食管反流而引起BE     

肺炎衣原体感染及炎症反应与冠心病的关系

目的探讨肺炎衣原体感染、炎症反应与冠心病的关系。方法选择2014年1月-2016年12月于医院诊断及治疗的冠心病患者80例为研究对象,分为急性心肌梗死组40例,心绞痛组40例,另选择同期健康体检者40名为对照组;检测并分析各组白细胞介素-6(IL-6)、C-反应蛋白(CRP)、纤维蛋白原(Fg)以及肺炎衣原体特异性抗体IgM以及IgG水平的差异,分析IL-6、CRP、Fg与心绞痛危险评分的关系,分析肺炎衣原体特异性抗体与IL-6、CRP、Fg的关系。结果急性心肌梗死组IL-6、CRP及Fg水平高于心绞痛组及对照组,心绞痛组高于对照组(P<0.05);心绞痛患者随着危险分数的升高,IL-6、CRP及Fg水平也呈上升的趋势(P<0.05);急性心肌梗死组与心绞痛组肺炎衣原体特异抗体IgG阳性率高于对照组(P<0.05);IgG阳性患者IL-6及CRP水平高于阴性患者(P<0.05);Pearson相关分析结果显示,肺炎衣原体特异性抗体IgG阳性与IL-6、CRP及Fg呈正相关关系(r=0.441,0.472,0.395,P<0.05)。结论冠心病患者肺炎衣原体特异性抗体IgG水平升高,并且IgG与炎性指标有正相关关系,因此推断肺炎衣原体感染在冠心病的发生及发展过程中也发挥了重要的作用。     

降钙素原联合 C－反应蛋白在儿童肺炎早期诊断中的意义

目的：探讨血清降钙素原（Procalcitonin,PCT）和C－反应蛋白（C－Reactive Protein,CRP）检测在不同类型儿童肺炎早期诊断中的临床应用价值。方法选取2015年1月至2016年1月徐州市妇幼保健院收治的264例肺炎患儿,根据病原学检查分为2组,细菌性肺炎组130例,非细菌性肺炎134例,同期选择116例健康儿童为对照组,测定血清PCT和CRP情况,进行分析。结果细菌性肺炎组与非细菌性肺炎组、对照组相比,PCT和CRP的表达水平有差异性,且差异有统计学意义（ F＝72．536, P＜0．001;F＝170．818,P＜0．001）;3组间PCT和CRP的阳性率比较有差异性,且有统计学意义（χ2＝0．036,P＜0．001;χ2＝0．037,P＜0．001）;PCT阳性时（＞0．05ng／mL）提示肺炎,敏感性为100％,特异性为19．2％;随着数值增大,特异性增加;当PCT值＞0．2ng／mL,敏感性为81．5％,特异性为99．6％,基本可确诊为细菌性肺炎;血清CRP特异性较高,当CRP＞6．0mg／L,敏感性为65．6％,特异性为100％,可确诊为细菌性肺炎。结论血清PCT在儿童肺炎早期诊断中敏感性较高,结合特异性较高的血清CRP,为临床早期细菌性肺炎的诊断提供了实验室依据,可以指导临床及时合理用药,值得在临床推广。     

老年脑梗死与幽门螺杆菌感染相关性研究

探讨幽门螺杆菌(helicobacter pylori,Hp)感染与脑梗死发生的关系。本研究采集脑梗死患者(46例)清晨空腹静脉血,同时选择未患有脑梗死且年龄60岁其他疾病患者(42例),分别测定两组人群血清中幽门螺杆菌特异性IgG、IgA、IgM抗体及脑梗死相关危险指标[C反应蛋白(CRP)、血清总胆固醇(TC)、甘油三酯(TG)、高密度脂蛋白胆固醇(HDL-C)、低密度脂蛋白胆固醇(LDL-C)、血浆纤维蛋白原(FIB)],采用颈部血管彩色多普勒检查颈部血管的狭窄程度、斑块有无,并对两组患者血清中幽门螺杆菌特异性IgG、IgA、IgM抗体阳性率进行比较分析,分析Hp感染与颈部血管病变、脑梗死相关因子水平的关系。结果显示,病例组血清幽门螺杆菌IgG抗体、IgA抗体、IgM抗体阳性例数(阳性率)分别是37(80.43%)、27(58.70%)、12(26.09%),对照组血清幽门螺杆菌IgG抗体、IgA抗体、IgM抗体阳性例数(阳性率)分别是24(57.14%)、12(28.57%)、3(7.14%),且三种特异性抗体阳性率在病例组和对照组比较的结果差异有统计学意义(P0.05)。IgG抗体阳性者颈动脉斑块及颈动脉狭窄的发生率均高于IgG抗体阴性者,两组比较差异有统计学意义(χ~2=18.011、4.023,均P0.05)。IgG抗体阳性者CRP水平及血FIB水平明显高于IgG抗体阴性者,两组比较差异有统计学意义(t=3.482、3.433,均P0.05)。人体幽门螺杆菌感染可能是促进脑梗死发生的危险因素之一,Hp感染可能诱导血管炎症发生,参与动脉斑块的形成,治疗脑梗死的同时应考虑Hp的感染、发生和治疗。     

Serological markers of Chlamydia pneumoniae,cytomegalovirus and Helicobacter pylori infection in diabetic and non-diabetic patients with unstable angina pectoris

The possible role of inflammation in coronary artery disease (CAD) is being recognised, while markers of inflammation (e.g., CRP) and infection with Chlamydia pneumoniae (C. pneumoniae), cytomegalovirus (CMV) and Helicobacter pylori (H. pylori) have been proposed as risk factors for CAD. However, these associations require further evaluation. It is a known fact that diabetic patients suffer from impaired immune response to some pathogens and a high incidence of atherosclerosis. In this case-control study we investigated serological markers of infection with C. pneumoniae, CMV, and H. pylori in a group of 140 patients with unstable angina pectoris (UA), 52 of them having type 2 diabetes mellitus, and in a matched control group. Anamnestic (IgG) and acute infection (IgA) antibodies against the above agents were tested using ELISA or indirect immunofluorescence tests. In patients with UA we found a significantly higher seroprevalence and titres of IgG antibodies against C. pneumoniae (p = 0.04) and increased titres of IgG antibodies against CMV (p = 0.007). No differences were found in IgA antibody response to these pathogens. Antibody response to H. pylori was similar in both groups tested. In diabetic patients with UA, the frequency of group-common IgG antibodies against C. pneumoniae was higher than in the non-diabetic UA patients. The other serological markers studied were comparable in the patients with or without diabetes mellitus. Our findings confirmed association of C. pneumoniae and CMV with cardiovascular heart disease. Moreover, diabetes mellitus may predispose the patients to C. pneumoniae infection. However, serological markers observed do not indicate that destabilisation of angina pectoris is associated with acute C. pneumoniae or CMV infection. No relationship was found between UA and H. pylori infection.     

根除幽门螺杆菌对外周血白细胞和C-反应蛋白的影响

目的 探讨根除幽门螺杆菌对外周血白细胞和CRP的影响.方法回顾性分析158例幽门螺杆菌阳性患者经标准三联1周根除治疗后的临床资料,其中Hp根除组108例,Hp未根除组50例,观察两组患者治疗前及结束时、1个月、12个月外周血白细胞和CRP的变化.结果 108例成功根除Hp患者外周血白细胞、中性粒细胞和单核细胞明显减少,其CRP水平也较治疗前显著降低(P<0.05).但嗜酸性粒细胞、嗜碱性粒细胞、淋巴细胞计数则无显著变化(P>0.05).50例未根除Hp患者治疗前后上述参数均无明显变化(P>0.05).结论 Hp感染可导致外周血白细胞、中性粒细胞、单核细胞和CRP水平增加,表明Hp感染可能是一种全身性的炎性反应.     

C-reactive protein,Helicobacter pylori,Chlamydia pneumoniae,cytomegalovirus and risk for myocardial infarction

PURPOSE: C-reactive protein (CRP), Chlamydia pneumonia, Helicobacter pylori, and cytomegalovirus (CMV) have each been associated with atherosclerosis. We assessed how infection and CRP related to risk for subsequent myocardial infarction (MI). METHODS: Using a nested case-control design, we assessed how these factors independently and jointly affected risk for myocardial infarction (MI). Cases of first MI (N = 121) were identified from among participants in a multiphasic health check-up cohort. Controls without MI (N = 204) were matched to cases by gender, age, race, and date of serum collection. Sera collected at enrollment were tested for antibodies to infection and for CRP. RESULTS: In multivariate analysis (mean follow-up of 5.1 years), CRP was associated with MI only in subjects older than 51 years (p = 0.004). Although H. pylori infection increased risk for MI, this association was modest (OR = 1.90, 95% CI = 0.97-3.71) and was not evident in non-smokers or when adjusted for education. No association between C. pneumoniae or cytomegalovirus and MI was observed, nor was the association between CRP and MI explained by these infections. CONCLUSIONS: Elevated CRP is a risk factor for subsequent MI in older individuals. The relationship between Hp and MI may be due to confounding or co-linearity with socioeconomic status.     

血清铁蛋白与冠状动脉粥样硬化病变程度及预后的关系

目的探讨血清铁蛋白与冠状动脉粥样硬化(CAD)病变程度及近期预后的关系。方法根据冠状动脉造影结果,将140例病人分组,66例诊断CAD,记录常见心血管危险因素,测定血清铁蛋白、C反应蛋白(CRP)及血脂。分析铁蛋白、CRP与常见心血管危险因素及它们的关系,并进行近期随访。结果CAD患者铁蛋白水平显著增高(P<0.01);多元线性回归分析,铁蛋白与TG(P=0.011)、性别(P=0.033)相关;二维logistic回归分析,CAD病变程度与铁蛋白(P=0.01)、年龄(P=0.001)、吸烟(P=0.012)相关;近期心脏事件患者铁蛋白水平显著增高(P<0.01)。结论在排除了炎症反应的影响下,血清铁蛋白与CAD病变程度独立相关,并对CAD患者近期预后有预测价值。     

Free protein S level as a risk factor for coronary heart disease and stroke in a prospective cohort study of healthy United Kingdom men

Plasma protein S (PS) levels are reportedly low in patients with venous thrombosis but high in coronary heart disease (CHD) patients. The authors examined the association between free PS concentration and CHD or stroke risk and assessed risk in combination with C-reactive protein (CRP) levels. Free PS concentration was determined in 6 annual visits among 3,052 middle-aged (49-64 years) United Kingdom men from the Second Northwick Park Heart Study, with 297 CHD events from 1989 to 2005. The highest (vs. first) quintile was associated with a significantly increased CHD risk after adjustment for all other risk factors and correction for regression dilution bias (hazard ratio = 1.85, 95% confidence interval: 1.08, 3.16; P = 0.024). Models that included all well-known risk factors plus PS quintiles improved prediction of CHD (net reclassification improvement (NRI) = 7.0% (P = 0.007), category-less NRI (>0) = 22.1% (P < 0.001)), and the likelihood ratio statistic increased significantly (P = 0.018). The increase in CHD risk was particularly strong when subjects also had high CRP levels. There was no association between free PS level and stroke risk. This study confirms the independent association of elevated free PS levels with future risk of CHD, although elevated PS levels added only modestly to prediction metrics. The novel finding of increased CHD risk, particularly when CRP and PS levels are high, requires further study.     

Seroprevalence of cytomegalovirus in patients with and without coronary artery diseases at Madani Heart Center, Iran

Inflammation plays a major role in coronary artery disease (CAD). Currently, it is unclear, whether Cytomegalovirus (CMV) infection is associated with the risk of the atherosclerosis. The aim of this study was to determine the prevalence of anti- CMV antibodies in CAD and non CAD patients undergoing artery bypass surgery. Sera from 157 patients who underwent coronary angiography were tested for CMV by enzyme linked immunosorbent assay (ELISA) at Madani Heart Hospital, Tabriz University of Medical Sciences, Iran. Our study population was 58.6% male and 41.4% female, with an age range of 38 to 86 years. The prevalence of CMV positivity tended to be higher in coronary artery diseases patients than in those without non coronary artery diseases (83.2% versus 63.6%) (P= 0.01). This analysis demonstrated that CMV seropositivity may be a risk factor for CAD in the present study population.     

Low plasma vitamin B-6 concentrations and modulation of coronary artery disease risk

BACKGROUND: Low concentrations of pyridoxal-5'-phosphate (PLP), the active metabolite of vitamin B-6, are associated with high C-reactive protein (CRP) concentrations. Both low PLP and elevated inflammatory markers, such as high-sensitivity CRP (hs-CRP) and fibrinogen, are related to higher risk of coronary artery disease (CAD). OBJECTIVES: The objectives were to evaluate the relation between PLP and acute-phase reactants in affecting CAD risk and to estimate the risk of CAD related to low plasma PLP, either alone or in combination with high concentrations of acute-phase reactants and other classic risk factors for CAD. DESIGN: A case-control study was conducted with 742 participants: 475 with severe multivessel CAD and 267 free from coronary atherosclerosis (CAD-free). We measured plasma PLP, fibrinogen, hs-CRP, and serum lipid concentrations and all major biochemical CAD risk factors, including total homocysteine. RESULTS: A significant, inverse, graded relation was observed between PLP and both hs-CRP and fibrinogen (P < 0.001). The prevalence of PLP concentrations in the lower half of the population (<50th percentile: 36.3 nmol/L) was significantly higher among CAD patients than among CAD-free subjects (P < 0.001). The odds ratio for CAD risk related to low PLP concentrations after adjustments for the major classic CAD risk factors, including hs-CRP and fibrinogen, was 1.89 (95% CI: 1.18, 3.03; P = 0.008). The CAD risk as a result of low PLP was additive when considered in combination with elevated hs-CRP concentrations or with an increased ratio of LDL to HDL. CONCLUSION: Low plasma PLP concentrations are inversely related to major markers of inflammation and independently associated with increased CAD risk.     

冠心病患者C反应蛋白、丙二醛与von Willebrand因子检测及辛伐他汀干预后的变化

目的　检测各型冠心病患者外周血炎症标志物C反应蛋白 (CRP)、丙二醛 (MDA)与vonWillebrand因子(vWF)以及辛伐他汀对冠心病患者调脂以外的作用。方法　血脂正常的冠心病患者 14 0例 ,其中稳定性心绞痛(SAP) 4 0例 ,不稳定性心绞痛 (UAP) 5 0例 ,急性心肌梗死 (AMI) 5 0例。每种病例随机分为两组 ,一组为辛伐他汀治疗组 ,一组为常规治疗组 ;正常对照组 2 0例。分别于入院时及治疗后 1周两次检测上述标志物。结果　三组病例的CRP、MDA、vWF均显著高于对照组 (P <0 .0 0 1) ,AMI组显著高于SAP及UAP组 (P <0 .0 0 1) ;辛伐他汀治疗组可以使三种指标显著下降 (P <0 .0 5 )。结论　炎症反应、氧化应激及血管内皮损伤在冠心病的发病机制及进展中起重要作用 ,辛伐他汀可以抑制炎症反应、氧化应激 ,修复内皮从而稳定病变进展。     

监测结直肠癌患者幽门螺杆菌感染及血清胃泌素水平的临床意义

目的 研究幽门螺杆菌(Hp)感染及血清胃泌素水平与结直肠癌发病的相关性.方法 结直肠癌组47例及经全结肠镜检查未见明显异常或仅轻度慢性炎性反应的对照组30例,EUSA法检测血清HpIgG,以及14C尿素呼气试验和/或快速尿素酶试验,三者中至少两项阳性为存在Hp感染;入选者均用ELISA法检测其空腹血清胃泌素水平.结果 结直肠癌组Hp感染率[61.7%(29/47)]显著高于对照组[36.7%(11/30)](P<0.05);其中远侧结直肠癌患者较对照组及结直肠癌组的女性患者较对照组的女性患者均有增高,差异有统计学意义(P<0.05).结直肠癌组血清胃泌素水平[(139.7±53.3)nv/L]显著高于对照组[(89.5±26.1)mg/L](P<0.01);其中以远侧结直肠癌患者为著.结论 高Hp感染率及其引发的血清胃泌素水平增高,与结直肠癌的发病呈正相关.