Cag(+)幽门螺杆菌感染对急性冠脉综合征患者冠状动脉病变的影响

目的探讨Cag(+)幽门螺杆菌(Helicobacter pylori,Hp)感染对急性冠脉综合征患者冠脉动脉粥样硬化的影响及可能机制。方法根据呼气试验及抗Cag抗体水平将确诊为急性冠脉综合征患者144例分为3组:H pylori-CagA-组(n=27)、H pylori+CagA-组(n=63)及H pylori+CagA+组(n=54)。采用Gensini评分来评估患者的冠状动脉粥样硬化的程度。检测患者血脂、血尿酸、血纤维蛋白原、血清低密度脂蛋白、血清超敏C反应蛋白(high sensitive C reactive protein,hsCRP)及氧化低密度脂蛋白(oxidized low density lipoprotein,oxLDL)浓度,并进行比较。结果方差分析显示,3组冠状动脉Gensini评分比较,差异有统计学意义(P0.05)。H pylori+CagA+组冠状动脉Gensini评分明显高于H pylori-CagA-组、H pylori+CagA-组,差异有统计学意义(69.02±42.52)分vs.(44.48±40.72)分,P0.05;(69.02±42.52)分vs.(44.91±37.65)分,P0.05]。H pylori-CagA-组与H pylori+CagA-组冠状动脉Gensini评分比较,差异无统计学意义(44.48±40.72)分vs.(44.91±37.65)分,P0.05]。方差分析显示3组血清总胆固醇、低密度胆固醇、载脂蛋白B、oxLDL及hsCRP浓度比较,差异均有统计学意义(P0.05);与H pylori-CagA-组比较,在H pylori+CagA-组及H pylori+CagA+组上述指标明显升高,其中H pylori+CagA+组水平最高,差异有统计学意义(P0.05)。结论 H pylori+CagA+能增加急性冠脉综合征患者冠脉粥样硬化的风险,其可能通过影响脂质代谢、加速低密度脂蛋白的氧化及激活炎症反应来促进冠状动脉的动脉粥样硬化发展。

Effect of CagA-positive Helicobacter pylori strains on coronary atherosclerosis in patients with acute coronary syndrome

Objectives To investigate the effect of CagA-positive Helieobacter pylori （H pylori） strains infection on coronary atherosclerosis in patients with acute coronary syndrome and possible mechanism. Methods All 144 acute coronary syndrome patients were divided into 3 groups, including H pylori^-CagA^- group （n=27）, H pylori^＋CagA^-group （n=63）and H pylori^＋CagA^＋ group（n=54）. The severity of coronary heart disease was estimated by calculating the Gensini score. Concentrations of serum total cholesterol, low density lipoprotein cholesterol, apolipoprotein B, high sensitive C- reactive protein （hsCRP）and oxidized low density lipoprotein （oxLDL） were examined and compared. Results Analysis of variance indicated that there was significant difference of Gensini score among the 3 groups （P〈0.05）; Gensini score of H pylori ^＋CagA^- group was significantly higher than those of H pylori^-CagA^- group and H pylori ^＋CagA^- group （69.02 ±42.52 ） score vs. （ 44.48±40.72 ） score, P〈 0.05 ; （ 69.02 ±42.52 ） score vs. （ 44.91 ± 37.65 ） score, P〈0.05 ]. There was no significant difference of Gensini score between H pylori^-CagA^-group and H py]ori^＋CagA^- group （44.48±40.72） score vs. （44.91 ±37.65）score,P〉0.05]. Analysis of variance indicated that there was significant difference of concentrations of serum total cholesterol, low density lipoprotein cholesterol, apolipoprotein B, hsCRP and oxLDL among the 3 groups （P〈0.05） ;Compared with H pylori^-CagA^- group,the above-mentioned indexes of H pylori^＋CagA^- group and H pylori^＋CagA^＋ group were significantly higher,and those of H pylori^＋CagA^＋ group were the highest （P〈 0.05）. Conclusions More serious coronary atherosclerosis was observed in acute coronary syndrome patients with H pylori ^＋CagA^＋ infection. H pylori^＋CagA^＋ infection might be involved in coronary atherosclerosis by modifying serum lipids, enhancing low density lipoprotein oxidation and activating the inflammatory responses.