肺炎衣原体感染对冠心病发病影响的临床观察

目的 研究肺炎衣原体(Cpn)感染与冠心病(CHD)的关系.方法 应用酶联免疫吸附试验(ELISA)测定冠心病组(120例)和对照组(111例)血清Cpn特异性抗体IgM、IgG及IgA,同时应用免疫浊度法测定冠心病组(97例)和对照组(95例)血清C-反应蛋白(CRP)含量.结果 冠心病组血清Cpn抗体IgG和/或IgA阳性率及IgG和IgA滴度明显高于对照组(均P<0.05);急性心肌梗死(AMI)、不稳定型心绞痛(UAP)及慢性冠心病(CCHD)患者血清Cpn抗体IgG及IgA滴度均分别高于对照组(均P<0.05);冠心病组Cpn抗体IgM阳性率及滴度与对照组无明显差异;IgG和/或IgA及CRP均为阳性组的冠心病发生率明显增高;多元回归分析显示Cpn慢性感染与冠心病发病呈正相关(P=0.045),Cpn慢性感染与冠心病其他危险因素间无相关性.结论Cpn慢性感染可作为冠心病的独立危险因素,炎症反应的发生可能是Cpn慢性感染导致动脉粥样硬化的关键环节.     

感染、炎症与冠心病关系的临床研究

目的　探讨肺炎衣原体 (CP)感染及可溶性细胞间粘附分子 - 1(s ICAM- 1)与冠心病 (CHD)的关系。方法　采用酶标法 (EIA)测定冠心病组 (6 0例 )和对照组 (6 0例 )血清 CP特异性抗体 Ig G,同时应用 EL ISA法测血清 TNF,s ICAM- 1的浓度。结果　急性心肌梗死组 (2 0例 ) CP Ig G阳性 17例 (85 % ) ,不稳定型心绞痛组 (2 0例 )阳性 16例(80 % ) ,稳定型心绞痛组 (2 0例 )阳性 14例 (70 % ) ,对照组阳性 30例 (5 0 % )。急性心肌梗死组、不稳定型心绞痛组与正常对照组相比 ,差异有显著性 (P<0 .0 5 ) ;冠心病组、急性心肌梗死组、不稳定型心绞痛组与正常对照组相比 ,血清 TNF、s ICAM- 1显著增高 (P<0 .0 1)。结论　患者 CP感染、脂质代谢紊乱、粘附分子表达增加、TNF- α作用可能参与了冠心病发生、发展的过程     

氟伐他汀对冠心病患者PAPP-A和ox-LDL水平的影响

目的观察氟伐他汀治疗对冠心病患者妊娠相关血浆蛋白-A（PAPP-A）和氧化型低密度脂蛋白（ox-LDL）水平的影响。方法选择冠心病组患者75例,包括急性心肌梗死（AMI）患者32例,不稳定型心绞痛（UAP）患者22例和稳定型心绞痛（SAP）患者21例。正常对照组60例。采用双抗体夹心酶联免疫吸附试验检测冠心病患者PAPP-A和ox-LDL水平。结果PAPP-A在急性冠脉综合征组（ACS,包括AMI、UAP）浓度较SAP及正常对照组均明显偏高（P<0.05）;ox-LDL在冠心病组中的浓度较正常对照组高（P<0.05）,且在AMI、UAP、SAP各组组间比较均有显著性差异（P<0.05）;氟伐他汀治疗后冠心病患者PAPP-A和ox-LDL浓度均显著下降（P<0.01）;PAPP-A与ox-LDL水平呈正相关（P<0.01）。结论氟伐他汀治疗后冠心病患者PAPP-A和ox-LDL浓度降低,氟伐他汀可能通过抑制炎症反应,减少氧化应激来发挥心血管的保护作用。     

Inflammation and infection in stable coronary disease and acute coronary syndrome

OBJECTIVE: To study whether inflammation and infection are related to coronary artery disease. DESIGN: Sixty patients (44 males, mean age 62 +/- 13 years) with acute coronary syndrome and 40 with stable coronary artery disease (31 males, age 64 +/- 10 years) and a control group of 40 individuals (34 males, 53 +/- 5 years) were analyzed. IgG against Chlamydia pneumoniae, Cytomegalovirus and Helicobacter pylori plus C-reactive protein were assessed in all serum samples. In addition, IgM against C. pneumoniae and Cytomegalovirus on admission and C-reactive protein one month later were measured in acute patients. RESULTS: No IgM seropositivity was observed. A high prevalence of IgG seropositivity with no significant differences among the groups was found: C. pneumoniae: acute group 44 (73%), stable group 29 (73%) and control group 25 (63%); Cytomegalovirus: 55 (92%), 37 (92%) and 38 (95%), respectively; and H. pylori, 43 (72%), 32 (80%) and 34 (85%) respectively. There was a high rate of positive C-reactive protein in the acute group: 48 (80%) vs 10 (25%) the stable group and 0% the control group (p < 0.001). C-reactive protein levels were higher in Q-wave infarction than in unstable angina/ non-Q-wave infarction (median 22.65 vs 7.69, p < 0.001). One month later, C-reactive protein levels decreased (median 22.65 vs 3.38, p < 0.001), but were still positive in 40%. CONCLUSIONS: These data suggest that inflammation is detected by the commonly used methods in clinic practice in acute coronary syndromes and to a lesser extent in stable coronary artery disease. It seems that different mechanisms other than infection account for this inflammatory response, at least this being so when infection is assessed by serology. Serology does not appear to be an adequate method to determine the possible relationship among coronary syndromes, infection and inflammation.     

Association of seropositivity for antibody to Chlamydia-specific lipopolysaccharide and coronary artery disease in Japanese men

Recent studies suggest an association between Chlamydia pneumoniae infection and coronary artery disease (CAD). To examine this relationship in Japanese men, serum IgA and IgG antibodies to Chlamydia-specific lipopolysaccharide were measured by enzyme-linked immunosorbent assay in 507 patients with CAD and 200 age-matched controls. CAD patients were divided into (1) 269 patients with myocardial infarction (MI) and (2) 238 patients with chronic coronary heart disease (CCHD). Compared with the control group, the CAD group did not differ in the prevalences of both antibodies (IgA: 23.7 vs 18.0%, p=0.10; IgG: 52.7 vs 51.0%, p=0.6). The index of IgG antibody was not significantly different between CAD and control groups (median 1.19 vs 1.18, p=0.3), whereas the index of IgA antibody was significantly higher in CAD than control group (median 0.60 vs 0.46, p<0.0001). Compared with the control group, the MI group had a significantly higher prevalence of IgA antibody (28.6 vs 18.0%, p=0.007); however, there was no difference in the prevalence of IgG antibody (58.0 vs 51.0%, p=0.13). The CCHD group did not differ in the prevalences of both antibodies (IgA: 18.1 vs 18.0%, p=0.9; IgG: 45.6 vs 51.0%, p=0.2). After the adjustment for coronary risk factors, odds ratios (ORs) of seropositive antibodies for CAD were 1.59 [95% confidence interval (CI): 0.88-2.87, p=0.12] for IgA seropositivity and 0.92 (95%CI: 0.58-1.47, p=0.7) for IgG seropositivity in all cases. In the MI and control groups, ORs of seropositive antibodies for MI were 2.67 (95%CI: 1.32-5.38, p=0.007) for IgA seropositivity, and 1.36 (95%CI: 0.79-2.36, p=0.2) for IgG seropositivity. This study discovered that IgA antibody to Chlamydia was significantly associated with CAD, especially with MI, in Japanese Men and the findings suggest that chronic infection of Chlamydia may be linked to the pathogenesis of MI.     

Antibodies against Chlamydophila in patients with acute myocardial infarction and coronary risk and their association with mortality

OBJECTIVE: The primary aim of this study was to determine whether antibodies against Chlamydophila pneumoniae in patients with acute myocardial infarction (AMI) and coronary risk factors are associated with death. MATERIAL AND METHODS: A cross-sectional study was conducted among 100 patients hospitalized in the Coronary Unit of Centro Medico La Raza Hospital of the Mexican Institute of Social Security, between 1999 and 2000. Subjects were males and females older than 18 years, diagnosed with AMI and coronary risk. Antibodies against Chlamydophila pneumoniae, Chlamydophila psitacii and Chlamydia trachomatis were measured using an indirect microinmunofluorescence assay. In addition, blood samples from 33 patients from the original group were taken when the patients were discharged from the hospital,and 3 months after their myocardial infarction. Data analysis consisted of geometric means and standard deviations as well as odds ratios with 95% confidence intervals. RESULTS: Seventy percent of patients presented antibodies against Chlamydophila pneumoniae. Antibodies against Chlamydophila psittaci and Chlamydia trachomatis were not identified. No statistically significant association was found between antibodies and death in these patients with coronary risk factors and AMI. In the subgroup of 33 individuals 25 had antibodies against Chlamydophila pneumoniae and in 83% of them antibodies decreased three months after the AMI event. CONCLUSIONS: Even though patients with coronary risk factors and AMI had an increased seropositivity for Chlamydophila pneumoniae it was not significantly associated with death.     

Further evidence against the implication of active cytomegalovirus infection in vascular atherosclerotic diseases

The possible contribution of cytomegalovirus (CMV) to pathogenetic events associated with atherosclerotic lesion establishment and progression is still controversial. We evaluated the possibility that active ongoing CMV infection could be correlated to evolution of unstable atheromatous lesion, by analyzing patients suffering from unstable angina (n=61), acute myocardial infarction (n=43), stable angina (n=26) and peripheral arteriopathy (n=22) as compared to healthy subjects (n=30). Particularly, we assessed: past exposure to CMV by evaluating anti-CMV IgG antibodies; ongoing CMV infection by evaluating anti-CMV IgM antibodies and circulating interleukin (IL)-8 in serum; and CMV DNAemia in peripheral blood mononuclear cells (PBMC). Mean IgG values were significantly increased in patients from all groups, as compared to healthy subjects. CMV-specific IgM, as well as CMV DNAemia, were undetectable in both controls and patients. Circulating IL-8, significantly elevated in a group of individuals experiencing active CMV infection, was not significantly higher in cardiovascular disease patients, as compared to control subjects. These findings confirm previous evidence from the increased exposure to CMV infection in patients with atheromatous lesions. However, they provide further evidence against a direct implication of active systemic CMV infection in the pathogenesis of cardiovascular diseases, particularly those involving plaque instability.     

Evaluation of chlamydial IgM antibodies for clinical diagnosis]

Chlamydia trachomatis (C. trachomatis), C. psittaci, and C. pneumoniae are now well established as pathogens of respiratory infections including pneumonia. Serum samples from 223 infants and children with pneumonia, 31 patients with adult inclusion conjunctivitis, 16 parents of babies with neonatal inclusion conjunctivitis and others were tested for IgM antibodies to Chlamydiae. Diagnostic kits for chlamydial IgM antibodies (SeroELISA and IPAzyme) have been also evaluated for their diagnostic value. It was found that detection of specific IgM antibodies with SeroELISA has a diagnostic value in chlamydial pneumonias.     

Relationship of Chlamydia pneumoniae infection to severity of coronary atherosclerosis in patients with chronic coronary artery disease and with normal coronary arteries]

OBJECTIVES: Recent studies have demonstrated an association between infection with Chlamydia (C.) pneumoniae and coronary artery disease. However, the association is less clear in the Japanese population. The relationship of C. pneumoniae infection to severity of coronary atherosclerosis was investigated in patients with chronic coronary artery disease and with normal coronary arteries. METHODS: Serum levels of IgA and IgG antibodies to C. pneumoniae outer membrane complex were measured by enzyme-linked immunosorbent assay and C-reactive protein (CRP) analyses in 130 patients who underwent coronary angiography. Patients with unstable angina and recent myocardial infarction were excluded. Results were divided into three groups according to Gensini coronary score (GCS): normal (n = 19, GCS = 0); mild atherosclerosis (n = 56, GCS = 1-19); and severe atherosclerosis (n = 55, GCS > or = 20). RESULTS: Cut off indices of IgA and IgG in the atherosclerosis groups (severe: 1.53 +/- 0.72 and 1.67 +/- 0.97, mild: 1.58 +/- 0.92 and 1.42 +/- 0.86, respectively) were higher than in the normal group (1.22 +/- 0.59 and 1.28 +/- 0.82), but there were no significant differences. There were no correlations between indices of IgA and IgG, and GCS. The normal CRP group (n = 118, < 0.3 mg/dl) and the high CRP group (n = 12, > or = 0.3 mg/dl) showed no differences in IgA and IgG indices and GCS. CONCLUSIONS: Serum antibody indices against C. pneumoniae are not associated with the severity of coronary atherosclerosis in chronic stable coronary artery disease.     

Chlamydia pneumoniae in the atherosclerotic plaques of patients with unstable angina undergoing coronary artery bypass grafting: does it have prognostic implications?

Objective: This study sought to evaluate the prognostic significance of the presence of DNA of Chlamydia pneumoniae in the coronary atherosclerotic lesions of patients with unstable angina. Background: C. pneumoniae has been implicated in the pathogenesis of coronary artery disease by serological and pathological studies, but whether antichlamydial antibodies and the presence of this pathogen in the coronary atherosclerotic tissue are related to prognosis in unstable angina remains unclear. Methods: A total 76 coronary specimens from 45 patients with unstable angina undergoing bypass surgery were subjected to nested polymerase chain reaction (PCR) for C. pneumoniae. Antichlamydial immunoglobulin G (IgG), A (IgA) and M (IgM) were also examined by an enzyme immunoassay. Patients were followed during a 2-year period to determine the incidence of adverse cardiovascular events. Results: DNA of C. pneumoniae was detected in 57 (75%) of 76 atherosclerotic lesions: 39 patients showed a positive PCR result in at least one plaque. Of the 45 patients, 44 (97.7%) showed a positive serological result: IgG was positive in 39 (86.6%) patients, IgM in five (11.1%) patients and IgA in 42 (93.3%). Clinical characteristics and serologic results were similarly distributed in patients with and without infected lesions at enrollment. At least one adverse event occurred in 21 (46.6%) of the 45 patients at 2 years: death in nine (20%), recurrent angina in 12 (26.6%), revascularization in six (13.3%) and myocardial infarction in two (4.4%) patients. The composite endpoint of death, myocardial infarction, recurrent angina and revascularization at 2-year follow-up did not differ according to the PCR or serologic results. Conclusions: The presence of C. pneumoniae in coronary atherosclerotic plaques of patients with unstable angina undergoing coronary bypass grafting does not have prognostic significance. In addition, serology does not allow us to differentiate those patients with plaque infection by C. pneumoniae and also does not provide any prognostic information in these patients.     

Lipoprotein (a) is increased in acute coronary syndromes (unstable angina pectoris and myocardial infarction), but it is not predictive of the severity of coronary lesions

Lipoprotein (a) [Lp(a)] concentrations were determined in 365 patients undergoing coronary angiography for stable angina (n = 159), unstable angina (n = 99), recent myocardial infarction (n = 45), and nonischemic heart disease (cardiomyopathy or valvular disease, n = 62, non-IHD). Mean ± SD and median Lp(a) concentrations in stable angina (29.9 ± 29.2; 22 mg/dl) did not differ from those in non-IHD (26.9 ± 26.3; 17), but were significantly lower than in patients with unstable angina (52.7 ± 36.6; 58) and myocardial infarction (44.8 ± 36.4; 34) (p < 0.01). Coronary angiography revealed that 261 patients, including 4 patients in the non-IHD group, had significant (≥ 50%) coronary lesions. Lp(a) was higher in patients with (41 ± 35; 32) than in those without (28 ± 27; 19) angiographic evidence of significant coronary stenosis (p < 0.05) and showed a weak univariate correlation with the angiographic index (Total Score) of the severity of the disease (r = 0.106; p < 0.05). However, in the subgroup of 303 patients with stable/unstable angina or myocardial infarction, Lp(a) was predictive neither of angiographic presence nor of severity of coronary disease. Patients were then ranked according to the Total Score values. Among patients with comparable angiographic severity of coronary artery disease, Lp(a) appeared to be remarkably higher in patients with acute ischemic syndromes (unstable angina, myocardial infarction) than in patients with stable angina. In conclusion, Lp(a) was roughly twice as high in acute (unstable angina, myocardial infarction) than in chronic (stable angina) ischemic syndromes, but there was no difference between chronic stable angina and non-IHD. Serum level determination of Lp(a) made a poor contribution in predicting the extent of coronary artery disease.     

Seropositivity against Chlamydia pneumoniae in patients with coronary atherosclerosis

BACKGROUND: Results of therapy in patients with unstable coronary syndromes with antibiotics directed against Chlamydia pneumoniae have been variable, perhaps due to the heterogeneity of patients in these trials. HYPOTHESIS: The aim of the present study was to correlate the severity of coronary artery disease (CAD) with seropositivity against C. pneumoniae prospectively. METHODS: We measured the frequency of seropositivity (IgG levels > or = 1/64 and IgA levels > or = 1/16 against Chlamydia pneumoniae) in 110 patients with CAD and in 49 controls. RESULTS: As expected, traditional CAD risk factors were seen more often in patients with CAD than in controls. Mean values of total cholesterol (184 +/- 52 and 166 +/- 44 mg/dl, respectively) and triglyceride (143 +/- 60 and 112 +/- 63 mg/dl, respectively) in serum were significantly higher in patients with CAD than in controls (both p < 0.04). There were no significant differences between the two groups in serum high-density lipoprotein cholesterol (34 +/- 13 and 32 +/- 14 mg/dl, respectively) and lipoprotein (a) (Lp(a):241 +/- 247 and 223 +/- 263 mg/l, respectively) levels. The rate of IgG seropositivity was 52% (28/54) in patients with stable CAD, 41% (23/56) in patients with unstable CAD, and 35% in controls (p = NS). The rate of IgA seropositivity was 25% (14/54) in patients with stable CAD, 12% (6/49) in patients with unstable angina, and 12% (6/49) in controls (all p = NS). CONCLUSIONS: Only a small percentage of patients with CAD demonstrate seropositivity against Chlamydia pneumoniae. Antibiotic therapy in these selected patients, but not in the remaining patients, may be considered rational. These considerations may underlie the failure to see consistent benefits of antibiotic therapy in patients with CAD.     

血清脂蛋白(a)在冠心病的意义

目的探讨血清脂蛋白(a)与冠心病类型、病变、预后的关系。方法冠心病95例分为3组:急性心肌梗死组30例,不稳定型心绞痛组35例及稳定型心绞痛组30例。正常对照组30例。比较冠心病各组与对照组脂蛋白(a)。观察冠心病患者在住院期间及出院1个月内心脏性死亡等心脏事件。结果冠心病各组脂蛋白(a)均高于对照组,差异有统计学意义(P<0.05),脂蛋白(a)高于300mg/L患者心脏事件发生率55%(11/20),脂蛋白(a)小于或等于300mg/L患者心脏事件发生率19%(14/75),差异有统计学意义(χ2=5.439,P=0.02)。结论脂蛋白(a)是冠心病独立危险因素,与冠心病严重程度及预后相关。     

Early increase in levels of soluble inter-cellular adhesion molecule-1 (sICAM-1); potential risk factor for the acute coronary syndromes.

BACKGROUND: Studies have shown disparate results in relation to the role of plasma concentrations of cell adhesion molecules in atherosclerosis. Moreover, the differentiation of primary vs secondary alterations of these markers, in response to myocardial injury, has not been clear. We measured specific soluble cell adhesion molecules and inflammatory markers in men admitted acutely with chest pain and compared them to healthy controls. METHODS AND RESULTS: We prospectively studied men (total n=241), admitted acutely with chest pain (7.4+/-9.4 h, 71% within 10 h), unstable angina (n=67), acute myocardial infarction (n=47) and chest pain without ischaemic heart disease (n=45) and compared them with a stratified sample of randomly selected healthy controls (n=82). Soluble intercellular adhesion molecule (sICAM-1), endothelial selectin, vascular cell adhesion molecule, interleukin-6 and C-reactive protein were measured by ELISA and P-selectin expression by flow cytometry. Multiple regression analysis was used to control for the impact of classical risk factors. At baseline ICAM-1, interleukin-6 and C-reactive protein were significantly elevated in patient groups whereas no difference in vascular cell adhesion molecule or endothelial selectin was found. At 3 month follow-up, ICAM-1 level was unchanged in ischaemic heart disease patients. In all groups C-reactive protein and interleukin-6 levels were lower at review. ICAM-1 levels at follow-up were higher in ischaemic heart disease groups (but not in chest pain without ischaemic heart disease) relative to controls and remained so only in the unstable angina group following regression. sICAM-1, interleukin-6 and C-reactive protein strongly correlated with smoking. In the acute phase, ICAM-1 was confounded by smoking following regression and C-reactive protein and interleukin-6 remained significant in both ischaemic heart disease groups after multiple regression. There was no relationship to events which occurred in 23% of ischaemic heart disease patients (further acute myocardial infarction 5.3%, sudden cardiac death 0.9% or recurrent angina 16.7%). CONCLUSION: We found an inflammatory response with higher sICAM-1, interleukin-6 and C-reactive protein in patients presenting soon after developing an acute coronary syndrome. As sICAM-1 was not affected by the acute event this plasma marker may be an important risk factor for the development of the acute coronary syndrome, particularly unstable angina.     

C反应蛋白水平与冠心病的相关性研究

目的 探讨冠状动脉粥样硬化心脏病(CHD)与C反应蛋白(CRP)之间的关系.方法 测定50例正常对照人群和80例经冠状动脉造影证实为CHD患者血浆的CRP水平,其中单支病变30例、双支病变25例、三支病变25例;稳定型心绞痛31例、不稳定型心绞痛25例,急性心肌梗死24例.结果 CRP 水平在稳定型心绞痛组、不稳定型心绞痛组、急性心肌梗死组依次增高;稳定型心绞痛组(F=1.826,P＜0.05)、不稳定型心绞痛组(F=4.232,P＜0.01)及急性心肌梗死组(F=6.745,P＜0.01)的CRP水平均明显高于对照组,在冠心病组中,双支病变组(F=7.925,P＜0.01)以及三支病变组(F=9.467,P＜0.01)中CRP 水平也明显高于对照组.结论 CRP水平与冠心病和冠脉病变程度相关.     

幽门螺杆菌与冠心病的关系

目的：探讨幽门螺杆菌（HP）与冠心病（CHD）的关系。方法：268例冠心病不稳定型心绞痛患者均进行14C试验,根据检查结果分为HP阳性组（114例）和HP阴性组（159例）,每组患者均接受冠心病不稳定型心绞痛的标准治疗方案,分别观察两组患者3个月内心绞痛发生需要入院的情况与一年内心肌梗死发生率。结果：3个月内,两组因心绞痛再入院率无显著差异（χ2=0.76,P〉0.05）;一年内HP阳性组心肌梗塞发生率明显高于HP阴性组（5.3%比0.6%,P〈0.05）。结论：幽门螺杆菌与冠心病不稳定型心绞痛患者发生心肌梗死有一定关系,但是具体作用机制还需要进一步探讨。     

Chlamydia species as a cause of community-acquired pneumonia in Canada.

Chlamydia pneumoniae has been implicated as a cause of community-acquired pneumonia (CAP) in several studies. However, there has been no comprehensive study of the role of Chlamydia species (C. pneumoniae, C. psittaci (avian and feline strains) and C. pecorum) as a cause of CAP. The aim of the present study was to determine the role of C. pneumoniae, C. psittaci and C. pecorum as causes of CAP. A prospective cohort observational study of CAP was conducted at 15 teaching centres in eight Canadian provinces between January 1996-October 1997. Acute (n=539) and convalescent (n=272) serum samples were obtained for determination of antibody titres to C. pneumoniae, C. psittaci, C. pecorum, C. trachomatis, Mycoplasma pneumoniae, Legionella pneumophila serogroups I-VI, Streptococcus pneumoniae and various respiratory viruses. Twelve of 539 (2.2%) patients had acute C. pneumoniae pneumonia and an additional 32 (5.9%) had possible acute infection. C. pneumoniae was the sole pathogen in 16 of 42 (38.1%) of these patients. The most common copathogens were S. pneumoniae, respiratory syncytial virus and influenza virus type A. C. pneumoniae pneumonia patients were older and more likely to show congestive heart failure compared to bacteraemic S. pneumoniae patients. The latter had a lower mean diastolic blood pressure, a higher white blood cell count and a lower arterial carbon dioxide tension. Two patients had antibody titres suggestive of recent infection with the feline strain of C. psittaci. Although numerically Chlamydia pneumoniae is an important cause of community-acquired pneumonia, no distinctive clinical features associated with this pathogen were detected in the present study. Feline Chlamydia psittaci may cause a few cases of community-acquired pneumonia. Avian Chlamydia psittaci should be considered only if there is a compatible epidemiological history.     

冠心病患者同型半胱氨酸、脑钠肽与冠脉病变的相关性

目的：探讨冠心病（CHD）患者同型半胱氨酸（Hcy）、脑钠肽（BNP）与冠状动脉病变程度的关系及临床意义。方法：选择CHD患者80例,根据临床表现,心电图变化及心肌损伤标志物水平分为急性心肌梗死组（AMI组）,不稳定型心绞痛组（UAP组）和稳定型心绞痛组（SAP组）,并设正常对照组58例,测定所有研究对象血浆Hcy、BNP水平,并进行组间对比。结果：AMI、UAP组及SAP组血浆Hcy[（26.72±4.62）μmol/L比（20.28±4.05）μmol/L比（15.34±3.93）μmol/L]、BNP[（480.27±70.84）pg/ml比（312.25±62.54）pg/ml比（215.78±68.27）pg/ml]水平均明显高于正常对照组的[（11.27±3.58）μmol/L,（35.14±17.12）pg/ml],各组间比较差异均有显著性（P均〈0.05）;随着冠状动脉病变Gensini评分的增加,Hcy、BNP浓度明显升高（P〈0.05）。结论：冠心病患者血浆同型半胱氨酸、脑钠肽水平明显升高,与冠状动脉病变程度有关。     

微量免疫荧光标记法检测冠心病患者血清肺炎衣原体抗体

目的　测定冠心病患者的血清肺炎衣原体特异性抗体 ,探讨其临床价值。方法　应用间接微量免疫荧光标记法对 2 0 5例体检健康人群和 170例住院确诊的冠心病患者进行肺炎衣原体特异性抗体 Ig G、Ig M的检测。结果　体检健康人群 Ig G总阳性率 2 1.5 % ;均阴性 ;冠心病患者 Ig G总阳性率为 91.2 % ,Ig M阳性率为 5 % ,其中无症状型冠心病组、不稳定型心绞痛组及急性心肌梗死组肺炎衣原体总感染率分别为 96 .2 %、86 %、88.1% ,既往感染率分别为 76 .9%、6 2 .0 %、71.4 % ,急性感染率分别为 19.2 %、2 4 .0 %、16 .7%。总感染率、既往感染率及急性感染率冠心病组较健康人群组明显增高 (优势比分别为 4 .14、2 .88、19.2 4 ,95 %的可信区间分别为 3.18～ 5 .39、2 .2 1～ 3.74、2 .79～ 132 .6 7)。结论　微量免疫荧光标记法系目前冠心病患者血清检测肺炎衣原体特异性抗体 ,从而确定肺炎衣原体感染的一个敏感度高、特异性强 ,简单易行的方法之一。     

冠心病患者血清C反应蛋白和可溶性细胞间粘附分子1与肺炎衣原体感染的相关性

目的探讨冠心病患者血清炎症标志物C反应蛋白和可溶性细胞间粘附分子1水平的变化及其与肺炎衣原体感染的关系。方法采用酶联免疫吸附法检测60例急性心肌梗死、不稳定型心绞痛、陈旧性心肌梗死、稳定型心绞痛及40例对照者血清C反应蛋白、可溶性细胞间粘附分子1及肺炎衣原体抗体IgG、IgM。结果冠心病组肺炎衣原体IgG阳性率和浓度均高于对照组(P<0.01),冠心病各组之间肺炎衣原体IgG和IgM阳性率差异无显著性(P>0.05),急性心肌梗死组肺炎衣原体IgG浓度高于陈旧性心肌梗死组、不稳定型心绞痛组和稳定型心绞痛组(P<0.05);冠心病组C反应蛋白、可溶性细胞间粘附分子1水平高于对照组(P<0.01),急性心肌梗死组C反应蛋白、可溶性细胞间粘附分子1水平高于不稳定型心绞痛组、陈旧性心肌梗死组和稳定型心绞痛组(P<0.01),不稳定型心绞痛组C反应蛋白、可溶性细胞间粘附分子1水平高于稳定型心绞痛组(P<0.05);肺炎衣原体IgG浓度、C反应蛋白、可溶性细胞间粘附分子1之间有很好的相关性(P<0.05)。结论炎症标志物水平变化在一定程度上反映了冠心病患者病情变化,肺炎衣原体感染与冠心病有关,炎症、感染可能共同参与了冠心病的发生发展。