脑卒中与肺炎衣原体感染的相关性

目的探索肺炎衣原体(Cpn)慢性感染与脑卒中之间的关系。方法2002年3月-2006年1月来复旦大学附属金山医院就诊的25岁至72岁脑卒中患者60例为病例组,选择60名性别、年龄和种族等与病例组相匹配的无脑卒中者为对照组,用微量免疫荧光法检测血清中Cpn抗体(IgA、IgG),并比较血清总胆固醇(TC),甘油三酯(TG)水平的差异。结果在脑卒中组和对照组血清中,Cpn IgA的阳性检出率分别为75.0%(45/60)和38.3%(23/60),P<0.001;Cpn IgG的阳性检出率分别为58.3%(35/60)和43.3%(26/60),P>0.05。脑卒中组TC(5.75±0.74 mmol/L)高于对照组(4.62±0.76mmol/L),具有统计学意义(P<0.05),TG水平差别无统计学意义。结论肺炎衣原体慢性感染的血清学证据与脑卒中危险有关,IgA滴度比IgG可能是更好的危险标记物。这一发现表明,脑卒中与Cpn之间有着临床的紧密关联,有关病因学的关系,有待进一步研究。     

急性冠脉综合征患者血清肺炎衣原体、 人巨细胞病毒感染的血清学研究

目的　探讨急性冠脉综合征与肺炎衣原体、人巨细胞病毒感染之间的关系。方法　对 42例急性心肌梗死(AMI)患者、43例不稳定心绞痛 (UAP)患者和 33例健康对照者采用微量免疫荧光法 (Micro IFA)检测血清中肺炎衣原体特异性抗体IgG、IgM及其滴度 ,用间接酶联免疫吸附测定法测定血清中人巨细胞病毒抗体IgG和IgM。结果　三组研究对象中均未检出急性肺炎衣原体感染者。急性心肌梗死、不稳定心绞痛组和正常对照组肺炎衣原体慢性感染率分别为6 6 7%、6 2 8%和 36 4% ,其中急性心肌梗死组、不稳定心绞痛组肺炎衣原体慢性感染率均较对照组升高 ,有统计学差异(P <0 0 5 )。上述三组平均肺炎衣原体特异性抗体滴度分别为 1 42、1 37和 0 88,急性心肌梗死组较正常对照组升高 ,有显著性差异 (P <0 0 1)。不稳定心绞痛组较正常对照组升高 ,有统计学差异 (P <0 0 5 )。此外 ,急性心肌梗死组与不稳定心绞痛组之间肺炎衣原体慢性感染率及平均IgG滴度无统计学差异 (P >0 0 5 )。三组研究对象中仅检出 1例抗人巨细胞病毒抗体IgM阳性者 ,IgG阳性率分别为 34 2 %、2 1 6 %和 41 9% ,无统计学差异。结论　肺炎衣原体慢性感染与急性冠脉综合征之间存在一定的联系 ,人巨细胞病毒感染与急性冠脉综合征之间的关系仍需进一步的     

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.     

肺炎衣原体感染与原发性高血压的相关性研究

目的探讨肺炎衣原体(chlamydia pneumoniae,Cpn)感染与原发性高血压及其肾损害发生发展的关系.方法120例原发性高血压病患者(病例组),其中男性67例,女性53例,年龄39～75(59.81±9.67)岁,以同期我院健康体检筛选出的与病例组年龄及性别相匹配的30岁以上的健康人作为对照组,共118例,其中男64例,女54例.两组年龄、性别经检验分析无统计学差异.所有纳入对象排除脑出血、周围血管病、肺炎、肺结核、肿瘤及免疫性疾病.应用间接微量免疫荧光法测定血清肺炎衣原体特异性IgG、IgM抗体滴度,感染判断标准为急性感染单次IgM≥116或IgG≥1512;既往感染IgM＜116,164≤IgG＜1512.对病例组IgG抗体滴度高于164者用巢式PCR(nPCR)法测定其外周血单核细胞中肺炎衣原体DNA.同时测定所有病例组病例的尿微量白蛋白与尿肌酐的比值.结果对照组、病例组肺炎衣原体总感染数(率)分别为30、93(25.60%、77.5%),其中既往感染数(率)分别为30、80(25.60%、66.7%),急性感染数(率)分别为0、13(0%、10.8%).总感染率、既往感染率及急性感染率病例组明显增高(P＜0.001),相对危险度分别为9.98、5.8、0.48,95%可信区间分别为5.5～18、14、3.31～10.18、0.42～0.54);IgM抗体病例组仅3例阳性,对照组无一例阳性;与对照组比较病例组血清Cpn-IgG抗体平均几何滴度差异有非常显著性(P＜0.001);病例组Cpn感染93例中外周血单核细胞中肺炎衣原体DNA阳性数(率)为27(29%),尿微量白蛋白与尿肌酐的比值增高者视为有肾损害,占36例,Cpn-IgG抗体平均几何滴度与尿微量白蛋白与尿肌酐的比值无关系;Cpn-DNA阳性者尿微量白蛋白与尿肌酐的比值增高.结论肺炎衣原体感染与原发性高血压明显相关,血清中特异性抗体仅能反映患者曾经感染过肺炎衣原体,DNA的存在提示有肺炎衣原体的持续感染,并与原发性高血压伴早期肾损害密切相关.     

肺炎衣原体抗体IgA与动脉粥样硬化及再狭窄的相关性分析

目的 :探讨肺炎衣原体感染和炎症对冠状动脉 (冠脉 )粥样硬化和支架内再狭窄的影响。方法 :6 2 8例接受冠脉造影检查的患者根据造影结果分为冠脉粥样硬化组 (4 33例 )和非冠脉粥样硬化组 (195例 ) ,记录两组基线临床资料 ,检测血清肺炎衣原体抗体IgA及高敏的C反应蛋白 (CRP)。 2 6 1例冠脉内放置支架的患者分为感染组 (89例 )和非感染组 (172例 ) ,随访半年 ,再次冠脉造影检查 ,测量支架内管腔丢失率。结果 :冠脉粥样硬化组肺炎衣原体抗体IgA的阳性率及滴度均高于无冠脉粥样硬化组 (4 8.32 %∶2 6 .10 % ;1.31± 1.19∶0 .92± 1.12 ) ;血清CRP水平明显升高 [(34.6 7± 3.2 4 )mg/L∶(2 3.2 2± 3.2 7)mg/L],且随着病变程度加重而增加。肺炎衣原体感染组和非感染组再狭窄发生率分别为 2 7.0 %、2 1.3% ,差异无统计学意义。但有再狭窄者血清CRP水平明显高于无再狭窄者 [(36 .13± 4 .0 4 )mg/L∶(16 .5 1± 3.92 )mg/L]。 结论 :血清抗肺炎衣原体抗体IgA阳性与冠脉粥样硬化相关 ,但不能预示支架内再狭窄的发生 ;而CRP与冠脉粥样硬化和再狭窄的发生均相关 ,提示炎症反应不仅在动脉粥样硬化而且在支架内再狭窄的发生中均扮演重要角色。     

血清肺炎衣原体IgA抗体水平与缺血性脑卒中关系的研究

目的探讨血清肺炎衣原体IgA抗体水平与缺血性脑卒中发生的关系。方法采用病例对照研究的方法,对2002年10月至2004年7月中国医科大学附属第一医院临床流行病学教研室从彰武县农村调查发现的符合入选标准的117例缺血性脑卒中患者中随机抽取76例作为病例组,同时从该调查人群中选取80例与病例组相匹配的无脑卒中史者作为对照组,每人采血5mL,采用EIA试剂盒进行血清肺炎衣原体IgA抗体的检测。结果(1)病例组与对照组肺炎衣原体IgA抗体EIU均值分别为45.56±40.95和48.75±40.72,差异无显著性(P>0.05)。(2)病例组与对照组肺炎衣原体IgA抗体阳性率分别为72.4%和75.0%,两组间差异无显著性(P>0.05),优势比OR=0.873(95%可信区间0.428～1.782)。(3)对缺血性脑卒中发生及其危险因素的多元Logistic回归分析,得到的调整IgA抗体阳性率与缺血性脑卒中的关系仍无显著性意义。结论肺炎衣原体抗体与缺血性脑卒中发生可能无关联。     

血脂生化检测在糖尿病诊治中的临床价值

目的探讨血脂生化检测在糖尿病诊治中的临床价值。方法随机选取具有可比性的同期到该院就诊的50例糖尿病患者(观察组)和50名健康体检者(对照组)为研究对象,应用同一台全自动生化分析仪,采用COD-PAP法测定血清总胆固醇,采用GPO-PAP法测定甘油三酯,采用表面活性剂清除法测定低密度脂蛋白,采用选择性抑制法测定高密度脂蛋白,具体检验操作步骤严格按照说明书执行,对两组研究对象的检测结果进行比较分析。结果对照组50名健康体检者的血清甘油三酯为(1.42±0.39)mmol/L,血清总胆固醇为(4.20±0.86)mmol/L,低密度脂蛋白为(2.35±0.78)mmol/L,高密度脂蛋白为(1.85±0.71)mmol/L;研究组50例糖尿病患者的血清甘油三酯为(2.44±0.32)mmol/L,血清总胆固醇为(5.81±0.91)mmol/L,低密度脂蛋白为(3.49±0.81)mmol/L,高密度脂蛋白为(0.76±0.64)mmol/L,两组研究对象TG、TC、LDL-C和HDL-C之间的差异均具有统计学意义(P0.05),对照组TG、TC、LDL-C低于观察组,对照组HDL-C高于观察组。结论糖尿病患者的血脂水平会出现明显异常,可作为糖尿病诊断和评价治疗效果的重要参考指标。在有效控制血糖的过程中,还应注意及时纠正血脂异常,使两者均尽快降至正常范围,对糖尿病患者转归和减少并发症产生明显促进作用。     

冠心病患者血清肺炎衣原体特异性抗体的测定

为探讨肺炎衣原体感染与冠心病的关系 ,应用微量免疫荧光试验方法测定 45例急性心肌梗死 ,32例陈旧性心肌梗死患者和 10 1例健康对照组肺炎衣原体特异性lgG和lgM抗体。结果发现肺炎衣原体慢性感染率为 :急性心肌梗死 95 .6 % (4 3/ 45 ) ,陈旧性心肌梗死 81.3% (2 6 / 32 ) ,而对照组为 5 6 .4% (5 7/ 10 1)。LgG抗体滴度几何均数分别为 95 .6± 113 .5 ,5 1.7± 39.1和 35 .3± 33.7。急性心肌梗死和陈旧性心肌梗死患者血清肺炎衣原体慢性感染率及其抗体滴度几何均数均明显高于对照组。提示肺炎衣原体感染可能与冠心病有关。     

肺炎衣原体感染与冠心病的相关性研究

目的通过测定血清肺炎衣原体(TWAR)IgG、IgM抗体滴度水平,探讨肺炎衣原体感染与冠心病的相关性.方法应用间接微量免疫荧光法,测定115例冠心病病人(冠心病组)和60例健康人(正常对照组)血清肺炎衣原体IgC、IgM抗体滴度.结果冠心病组病人血清肺炎衣原体IgG平均几何滴度(GMT)(157.77±4.42)与正常对照组(119.93±4.29)相比有非常显著性差异(P<0.001).冠心病组肺炎衣原体既往感染阳性率明显高于正常对照组(70.4%vs36.7%,P<0.001),2组急性感染阳性率无明显差异(P>0.05).随着肺炎衣原体IgG抗体水平(IgG≥116)的增高,发生冠心病风险相对增高(OR4.36,95%CI 2.32～8.16).不稳定性心绞痛病人、急性心肌梗塞病人血清肺炎衣原体IgG平均几何滴度及感染阳性率均无明显差别,但两者与正常对照组相比均有非常显著性差异(P<0.001).结论研究结果表明,冠心病组病人肺炎衣原体感染率及血清肺炎衣原体IgG平均几何滴度均较高,有抗体者(IgG≥116)发生冠心病的风险相对增加,肺炎衣原体感染可能是构成冠心病发生发展的一个危险因子.     

承德市60岁以上居民2型糖尿病和血脂异常的关系分析

目的分析2型糖尿病和血脂异常的关系。方法随机选取2014年3月~2015年3月承德市60岁以上居民中被确诊为2型糖尿病患者80例和体检健康人80名作为研究对象,2型糖尿病患者为研究组,体检健康人为对照组。分别测定总胆固醇、检测血糖水平、甘油三酯、高密度脂蛋白和低密度脂蛋白指标。结果与对照组相比研究组血糖水平、总胆固醇、甘油三酯和低密度脂蛋白指标均升高,并且总胆固醇5.3 mmol/L和甘油三酯2.0 mmol/L的患者比例显著偏高,差异有统计学意义(P0.05)。结论 2型糖尿病患者容易引起脂代谢异常,并且血糖水平升高,血脂异常的几率也较高。因此,在治疗2型糖尿病的同时还应注意控制血脂水平,以降低血脂异常引起的心脑血管疾病等的发生几率。     

Association of Helicobacter pylori infection with elevated serum lipids

Helicobacter pylori causes a chronic gastric infection, which has been associated with coronary heart disease. To evaluate the mechanisms of this association, we studied whether the infection affects serum lipid levels as previously shown in acute infections. We analysed the serum samples of 880 males who participated in a reindeer herders’ health survey in Northern Finland in 1989. H. pylori IgG and IgA antibodies were measured by enzyme-linked immunosorbent assay and triglyceride, total cholesterol and high-density lipoprotein cholesterol concentrations by routine enzymatic methods. A total of 52% of the subjects were positive for both H. pylori specific IgG and IgA and 31% were antibody-negative. The serum triglyceride and total cholesterol concentrations were significantly higher in the males with positive IgG and IgA antibody titres for H. pylori than in the males with no signs of infection (1.20 vs. 1.03 mmol/l, P<0.001 and 6.59 vs. 6.11 mmol/l, P<0.001, respectively). The associations remained statistically significant in non-smokers after the adjustment for age, body mass index (BMI) and social class. The finding supports the hypothesis that chronic infections may modify the serum lipid profile in a way that increases the risk of atherosclerosis.     

Comparison of individuals with and without specific IgA antibodies to Chlamydia pneumoniae: respiratory morbidity and the metabolic syndrome

STUDY OBJECTIVES: To determine whether a correlation exists between markers for persistent Chlamydia pneumoniae infection, respiratory morbidity, and the metabolic syndrome. DESIGN: Case-control study. A group of individuals with serologic markers (specific IgA > or = 1/128) suggestive of persistent C pneumoniae infection were compared with a group of control subjects without IgA antibodies (< 1/32). SETTING: Apoteksg?rdens Health Care Center, Kopparberg, Sweden. PARTICIPANTS: One hundred case subjects (61 men and 39 women) and 100 control subjects matched for age and gender (mean age, 55 years). Measurements and results: Individuals completed a questionnaire on respiratory symptoms and smoking habits. Body mass index (BMI) was calculated, BP, and peak expiratory flow (PEF) were determined. Blood specimens were drawn for determination of high-sensitivity C-reactive protein (hsCRP), blood glucose level, serum lipids, and Chlamydia antibodies. No significant difference was found between case subjects and control subjects regarding myocardial infarctions, stroke, diabetes type II, BP, BMI, hsCRP, blood glucose levels, and serum lipids. Symptoms of both asthma and chronic bronchitis were more common in case subjects, as were symptoms of chronic upper respiratory tract infections (p < 0.005). Case subjects with asthma or chronic bronchitis had more chronic upper respiratory tract disorders (p < 0.05). Symptoms of chronic respiratory tract diseases increased parallel to increasing specific C pneumoniae IgA antibody titers (p < 0.0005). PEF percentage of the predictive value was inversely correlated (p < 0.0005) to IgA antibody titers. CONCLUSION: The data show that persistent increased levels of C pneumoniae IgA antibodies were associated with pronounced respiratory dysfunction. These data provide additional evidence suggesting that IgA antibodies may be a marker for persistent C pneumoniae infection.     

Chlamydia pneumoniae infection and acute exacerbation of chronic obstructive pulmonary disease (COPD)

The objective of the study was to investigate the possible association of Chlamydia pneumoniae (Cpn) in acute exacerbations of chronic obstructive pulmonary disease (COPD) patients. Thirty-eight acutely exacerbated COPD patients and 17 healthy smokers were enrolled in the study, as the study and control groups respectively. Nasopharyngeal swabs and paired serum samples for antibody testing of Cpn (microimmunofluorescence--MIF) were obtained from all subjects. Sputum cultures of COPD patients were also performed. No pathogenic bacteria were isolated from nasopharyngeal swabs in any subject. Serologic evidence of recent Cpn infection was observed in 13 (34%) COPD patients and in one (5%) control subject. The prevalence of Cpn IgG and IgM antibodies representing acute infection were significantly higher in COPD patients than in control subjects (P < 0.05 and P < 0.01 respectively). Prevalence of IgA antibodies and IgG pre-existing antibodies did not show any difference (P > 0.05). Microbiologic culture of the sputa yielded potentially pathogenic micro-organisms in 23 of 38 (60%) COPD patients. Alpha-haemolytic streptococcus (35%), Niesseria spp. (31%) and Candida spp. (9.5%) were most prominent micro-organisms in positive cultures. Although a high prevalence of IgG antibodies against Cpn was detected, it was the sole causative agent in only four (10%) patients. We conclude that a remarkable number of COPD patients (34%) are acutely infected with Cpn and it may either be the sole causative agent or frequently a co-agent in acute exacerbations.     

Chronic Chlamydia pneumoniae infection is a risk factor for the development of COPD

Smoking is the major risk factor for the development of Chronic Obstructive Pulmonary Disease (COPD), but epidemiological data suggest that other etiological factors may also be involved. Chlamydia pneumoniae (Cpn) is an established cause of acute and chronic upper and lower respiratory tract infections. Data obtained from in vitro and in vivo studies indicate that Cpn infection can be involved in the development of both small airways disease and emphysema, the two major components of COPD. The aim of this study was to investigate the possible association between chronic Cpn infection and COPD. The study population was comprised of 199 consecutive patients who underwent bronchoscopy due to longstanding airway symptoms and for whom spirometry and serum samples for serology were available. Acute and convalescent sera were analysed for specific IgG and IgA Cpn antibodies using microimmunofluorescence. Chronic Cpn infection, defined as persistent elevated titres of IgA > or = 1/64, was present in 85 patients. Chronic infection was associated with smoking and higher age, but no gender difference was observed. Thirty patients had COPD, defined as FEV1/FVC < 70% without any features of asthma. Patients with COPD were older than those without, and there was no association with gender in this group. A statistically significant association, remaining after correction for smoking, was observed between chronic Cpn infection and COPD, and there was a trend for decreasing lung function with increasing antibody titres. The results suggest that chronic Cpn infection may be an independent risk factor for the development of COPD.     

肺炎衣原体感染与慢性阻塞性肺疾病关系的研究

目的　探讨肺炎衣原体感染在慢性阻塞性肺疾病 (COPD)发病中的作用。方法　实验分 2部分 ,(1)动物实验 :雄性Wistar大鼠 4 0只 ,分为A、B、C、D组 ,每组 10只 ,除D组外分别予香烟烟雾吸入和 (或 )经气管滴入肺炎衣原体菌液。 6周后测肺功能 ,行肺部病变病理评分及PCR检测肺部肺炎衣原体感染情况。 (2 )临床研究 :用PCR测COPD患者 (17例 )及健康对照者 (19例 )肺脏肺炎衣原体DNA ,同时测血清肺炎衣原体IgG及IgA抗体。结果　 (1)B组和C组大鼠肺组织肺炎衣原体DNAPCR阳性率分别为 88 9%和 80 0 %。B组大鼠肺组织病理改变主要为炎性细胞浸润及小气道平滑肌增生 ,病理及肺功能改变均较A组显著 ;C组主要病理改变为气道壁炎性细胞浸润及平滑肌增生较明显 ,与D组比较差异有显著性 ,肺功能与D组比较无明显差异。 (2 )COPD患者血清IgG抗体阳性率为 82 4 % ,IgA为 5 8 8% ,均明显高于健康对照者 (P值均 <0 0 5 ) ;PCR检测患者肺组织肺炎衣原体DNA均为阴性。结论　肺炎衣原体感染与COPD无直接关系 ,即单纯肺炎衣原体感染不能引起COPD的发病 ,但它可在吸烟所致病变的基础上加重COPD的病理改变及气流阻塞。     

Evaluation and optimization of a commercial enzyme linked immunosorbent assay for detection of <Emphasis Type="Italic">Chlamydophila pneumoniae</Emphasis>IgA antibodies

Background  

Serologic diagnosis of Chlamydophila pneumoniae (Cpn) infection routinely involves assays for the presence of IgG and IgM antibodies to Cpn. Although IgA antibodies to Cpn have been found to be of interest in the diagnosis of chronic infections, their significance in serological diagnosis remains unclear. The microimmunofluorescence (MIF) test is the current method for the measurement of Cpn antibodies. While commercial enzyme linked immunosorbent assays (ELISA) have been developed, they have not been fully validated. We therefore evaluated and optimized a commercial ELISA kit, the SeroCP IgA test, for the detection of Cpn IgA antibodies.     

Sex hormones and high density lipoproteins in healthy males.

The serum concentrations of testosterone, androstenedione, oestradiol and total low polar oestrogens, mainly oestradiol and oestrone, were measured in 26 healthy male subjects. The subjects were divided into two groups each of them with low (less than 1.04 mmol/l) and high (greater than 1.56 mmol/l) levels of serum HDL cholesterol. The group with high HDL cholesterol had significantly higher testosterone than the other group. Positive correlations were established between HDL cholesterol and testosterone and total cholesterol and testosterone concentration in serum.     

单纯疱疹病毒感染与冠心病急性心肌梗死的关系

目的　探讨单纯疱疹病毒 (HSV )感染与冠心病心肌梗死的关系。方法　测定 5 1例急性心肌梗死 (AMI)和 42例陈旧性心肌梗死 (OMI)及 3 1例冠脉造影正常者 (对照组 )的HSV 1抗体、C 反应蛋白 (CRP)、血脂水平。结果　AMI组HSV 1IgG阳性率及水平高于对照组 (P <0 .0 5 ) ,血HSV 1DNA检测结果与之吻合。校正冠心病危险因素前、后 ,HSV 1IgG阳性与AMI均有相关关系 (OR4.2 66,OR3 .3 2 1)。AMI组中HSV 1( +)组CRP、TC、LDL C高于HSV 1( -)组(均P <0 .0 5 ) ,并且IgG与CRP、TC、LDL C呈正相关。 结论　HSV 1感染与AMI之间存在明显的相关性 ,与血脂、CRP也存在相关性