肺炎衣原体感染与原发性胆汁性肝硬化的相关性研究

目的 通过检测原发性胆汁性肝硬化(PBC)患者血清中抗肺炎衣原体(CP)IgG、IgM水平,探讨CP感染与PBC之间的相关性。 方法 采用CP酶联免疫固相吸附试验检测41例PBC患者(PBC组)、70例肝炎后肝硬化(疾病对照组,PHC组)和57名健康查体者(正常对照组)血清抗CP IgG、IgM抗体水平。 结果 PBC组和PHC组的抗CP IgG平均水平(RU/ml)较正常对照组高(46.8±43.4、49.5±45.2与28.3±32.7,P=0.042与P<0.001),但PBC组与PHC组之间差异无显著性(P=O.059);PBC组、PHC组抗CP IgG阳性率亦高于正常对照组(68.3％、71.4％与42.1％,x2值分别为5.389、11.110,P值均小于0.05),PBC组与PHC组差别无显著性(x2=0.378,P>0.05);PBC组患者的血清抗CP IgM阳性率最高(22.0％),明显高于其它两组。与正常对照组比较,PBC组抗CP IgG、IgM阳性的比率比(OR)分别为2.7(95％ CI:0.9～6.1)、5.1(95％ CI:1.4～18.5);血清抗CP IgG水平与总IgG浓度无相关性(r=-0.857,P=0.344),而抗CP IgM阳性与总IgM异常升高有关。 结论 血清学研究结果尚不能支持肺炎衣原体是PBC的一个始动因素这一观点,但CP感染可能是造成PBC中IgM升高的原因之一。     

Chlamydia pneumoniae infection and nonspecific aortoarteritis: search for a link with a nonatherosclerotic inflammatory arterial disease

BACKGROUND: The association between Chlamydia pneumoniae infection and atherosclerosis has gained recognition. However, the nature of this association is controversial. The infective link may not be specific for atherosclerosis and may also exist in other nonatherosclerotic arterial diseases. We investigated patients with nonspecific aortoarteritis for serological evidence of prior Chlamydia pneumoniae infection. METHODS AND RESULTS: Fifty patients each of nonspecific aortoarteritis and coronary artery disease with angiographic evidence of significant (>70%) coronary artery lesions were tested for the presence of IgG antibodies against Chlamydia pneumoniae by micro-immunofluorescence assay and compared with 50 age- and sex-matched normal healthy controls. The number of patients with nonspecific aortoarteritis who tested positive for Chlamydia pneumoniae antibodies (IgG) was not significantly different from controls (8 v. 7, p=ns). The mean titer amongst positive subjects in the two groups was also similar (1:40+/-40 v. 1:50+/-25; p=ns). Patients with coronary artery disease were significantly older than patients with nonspecific aortoarteritis and controls (53.2+/-5.8 v. 21.2+/-9.9 years and 24.5+/-5.2 years, p<0.01 for both) and showed a higher seroprevalence of prior Chlamydia pneumoniae infection (18 v. 8 and 7, p < 0.05 for both). The mean IgG titers of patients with coronary artery disease who tested positive were also significantly higher than the other two groups (1:98+/-34 v. 1:40+/-40, p<0.001 and 1:98+/-34 v. 1:50+/-25, p<0.01, respectively). CONCLUSIONS: In patients with nonspecific aortoarteritis, the seroprevalence of prior Chlamydia pneumnoniae infection is not more than that in healthy individuals of the same age group, but is significantly lesser than that in patients with coronary artery disease. Thus Chlamydia pneumoniae infection may not be associated with all forms of chronic inflammatory arterial lesions.     

冠状粥动脉样硬化性疾病患者肺炎衣原体抗体检测

目的 为探索肺炎衣原体（Ｃｐｎ）和冠状动脉粥样硬化性心脏病之间的关系。方法 应用间接微量免疫荧光试验分别检测了６１例冠心病患者与６１例正常对照组血清中抗ＣｐｎＩｇＧ和ＩｇＭ抗体。结果 患者组ＩｇＧ抗体阳性率为７８．７％,对照组为５４．１％;ＩｇＭ抗体阳性率分别为２６．２％和６．６％。两组ＩｇＧ和ＩｇＭ抗体阳性率差异均有显著性（Ｐ〈０．０１）。此外,两组ＩｇＧ抗体的几何平均滴度差异尤具有显著性。结论     

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.     

非典型病原菌致成人社区获得性肺炎患者的临床特点分析

目的 研究非典型病原菌感染在成人住院社区获得性肺炎中的重要地位,并对其临床特点进行分析.方法 收集2005年5月至2008年5月来自国内多中心的153例成人社区获得性肺炎住院患者急性期及恢复期双份血清和急性期痰标本,采用间接免疫荧光法检测肺炎衣原体IgG抗体及嗜肺军团菌IgG、IgA及IgM混合抗体滴度,采用被动凝集法检测肺炎支原体IgG、IgA及IgM混合抗体滴度,同时对153份急性期痰标本进行普通细菌培养.用回顾性分析方法了解非典型病原菌在成人社区获得性肺炎住院患者中的地位.结果 153例血清学检测结果中符合非典型病原菌致社区获得性肺炎诊断标准的52例(34.0%),其中47例为单一非典型病原菌感染,其中肺炎衣原体38例,肺炎支原体4例,嗜肺军团菌5例;5例为2种非典型病原菌混合感染,其中肺炎衣原体+肺炎支原体2例,肺炎衣原体+嗜肺军团菌3例;52例中合并细菌感染者11例.结论 非典型病原菌(肺炎衣原体、肺炎支原体及嗜肺军团菌)为成人住院社区获得性肺炎的重要致病菌,以肺炎衣原体为主,同时不能忽视合并细菌感染情况的存在.     

Lack of association between seroprevalence of Helicobacter pylori infection and primary biliary cirrhosis

AIM: To determine the association between seroprevalence of Helicobacter pylori (H pylori) infection and primary biliary cirrhosis (PBC). METHODS: In this case-control study, 149 consecutive patients (10 males, 139 females, mean age 58.2+/-11 years, range 26-82 years) suffering from PBC and 619 consecutive healthy volunteer blood donors (523 males, 96 females, mean age 47+/-5.3 years, range 18-65 years) attending the Hospital Blood Bank and residing in the same area were recruited. A commercial enzyme linked immunosorbent assay was used to detect anti-H pylori (IgG) antibodies in serum. RESULTS: Antibodies to H pylori were present in 78 (52.3%) out of 149 PBC-patients and in 291 (47%) out of 619 volunteers (P = 0.24, OR 1.24, 95% CI 0.85-1.80). In the subjects less than 60 years old, the prevalence of H pylori infection among PBC-patients (40/79) was slightly higher than in controls (50.6% vs 46.2%) P = 0.46, OR = 1.19, 95% CI: 0.72-1.95). In those over 60 years, the prevalence of H pylori infection was similar between PBC-patients and controls (54.2% vs 57.8%, P = 0.7, OR 0.86, 95% CI 0.36-2.07). CONCLUSION: There is no association between seroprevalence of H pylori infection and primary biliary cirrhosis.     

抗线粒体抗体与原发性胆汁性胆管炎临床血清学和肝硬化指标的相关性

目的探究首次就诊的抗线粒体抗体(AMA)阳性原发性胆汁性胆管炎(PBC)患者的AMA水平及其与临床指标的相关性。方法通过北京大学人民医院信息系统,收集2013年1月至2016年12月首次检测AMA和(或)M2型抗线粒体抗体(AMA-M2)阳性的1323例患者的临床资料,其中采用间接免疫荧光法183例、免疫印迹法431例、ELISA法709例;分为未诊断PBC组(973例)和新诊断PBC组(350例,其中非肝硬化者268例,肝硬化者82例)。709例采用ELISA法的患者中,未诊断PBC组567例,新诊断PBC组142例(PBC非肝硬化组115例,PBC肝硬化组27例)。183例采用间接免疫荧光法的患者中,未诊断PBC组118例,新诊断PBC组65例;其中AMA滴度为低滴度(1∶40~1∶80)者69例(未诊断PBC组53例,新诊断PBC组16例)、中滴度(1∶160~1∶320)者95例(未诊断PBC组59例,新诊断PBC组36例)、高滴度(≥1∶640)者19例(未诊断PBC组6例,新诊断PBC组13例)。比较各组患者的AMA水平,分析其与PBC临床指标免疫球蛋白(Ig)G、IgM、血小板计数、ALT、AST、GGT、ALP、血清总蛋白、TBil、总胆固醇,以及肝硬化指标天冬氨酸转氨酶与血小板比率指数(APRI)、基于四因子的纤维化指数(Fib-4)的相关性。统计学方法采用Mann-Whitney U检验、Kruskal-Wallis检验和线性回归分析。结果采用ELISA法检测的709例患者的AMA-M2滴度中位值为53 RU/mL,新诊断PBC组的血清AMA和AMA-M2中位水平均高于未诊断PBC组(1∶320比1∶80和180 RU/mL比47 RU/mL),差异均有统计学意义(χ^2=14.111,Z=-7.531,P均<0.01)。未诊断PBC组的AMA-M2值与年龄、IgG、IgM、AST、GGT、ALP、血清总蛋白、总胆固醇水平均呈正相关,均有统计学意义(Rho值=0.114、0.108、0.337、0.089、0.197、0.086、0.121、0.073,P均<0.05);新诊断PBC组的AMA-M2值与年龄、IgM、血清总蛋白、总胆固醇水平均呈正相关,与血小板计数呈负相关,均有统计学意义(Rho值=0.218、0.483、0.230、0.161、-0.183,P均<0.05);PBC非肝硬化组的血清AMA和AMA-M2中位水平均有低于PBC肝硬化组的趋势(1∶160比1∶320和174 RU/mL比495 RU/mL),但差异均无统计学意义(P均>0.05);PBC肝硬化组者组患者的AMA-M2值与IgM水平呈正相关(r=0.38,P=0.039),但与APRI、Fib-4均无明确相关性(P均>0.05)。采用间接免疫荧光法检测的183例患者的AMA滴度中位值为1∶160;未诊断PBC组中AMA低滴度、中滴度和高滴度者的IgM中位水平逐渐升高(分别为1.2、1.7和1.8 g/L),新诊断PBC组中AMA低滴度、中滴度和高滴度者的IgM、GGT、ALP的水平均逐渐升高(中位水平分别为1.5、3.7和4.1 g/L,144、182和317 U/L,137、168和221 U/L),差异均有统计学意义(χ^2=6.260、7.081、8.030、15.226,P均<0.05)。总体中未诊断PBC组男性的血清AMA-M2中位水平低于女性(41 RU/mL比50 RU/mL),差异有统计学意义(Z=-2.945,P=0.003);新诊断PBC组男性的血清AMA-M2中位水平有低于女性的趋势(113 RU/mL比206 RU/mL),但差异无统计学意义(P=0.257)。结论血清AMA水平与诸多临床指标有一定的相关性,并可能与PBC患者的疾病严重程度相关。     

肺癌患者肺炎衣原体感染的研究

目的 为了探索肺炎衣原体(Cpn)和肺癌的关系。方法 应用聚合酶链反应（PCR）和血清间接微量免疫荧光试验（MIF）检测肺癌80例,非肺癌基础肺病80例痰中Cpn DNA和血清中抗Cpn IgM、IgG抗体。结果 肺癌组Cpn急性感染率（42．5％）和慢性感染率（86％）均明显高于非肺癌肺病组（8．8％;71％）,肺癌合并Cpn急性感染者,除肺部罗音,胸片渗出性病变出现较高外,其他临床表现与无Cpn急性感染的肺癌无不同。结论 PCR是检测Cpn的有用方法,肺癌患者易患Cpn感染,Cpn感染与肺癌有一定的关系,值得临床重视。     

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.     

Chlamydia pneumoniae infection in adults with chronic cough compared with healthy blood donors.

In a small uncontrolled study, persistent cough has recently been found to be associated with serological evidence of acute Chlamydia pneumoniae infection. In order to assess whether C. pneumoniae plays a role in chronic cough, the prevalence of C. pneumoniae infection in 201 adult patients with chronic cough was compared with the prevalence in 106 healthy blood donors without respiratory tract symptoms in the preceding 3 months. A microimmunofluorescence antibody test was used to determine C. pneumoniae antibodies in the immunoglobulin (Ig)M, IgG and IgA fractions. Further, nasopharyngeal aspirates from the 201 patients were examined for C. pneumoniae deoxyribonucleic acid by polymerase chain reaction (PCR). As judged by serology, nine patients (4%) and one control (1%) had acute C. pneumoniae infection, and 92 patients (46%) and 42 controls (40%) had previous or chronic C. pneumoniae infection. Of the nine patients with acute infection, three were C. pneumoniae PCR positive, and they all had an IgM antibody titre response. The remaining six patients had either an IgG antibody titre of > or =512 (five patients) or an IgA antibody titre of > or =512 (one patient). None of these six patients had detectable IgM antibodies. The mean cough period for the five IgG positive patients (10.8 weeks) was significantly longer than the mean cough period for the remaining patient population (6.4 weeks; p=0.004). It is concluded that Chlamydia pneumoniae infection was not statistically significantly more prevalent in patients with chronic cough than in healthy blood donors, and that Chlamydia pneumoniae appears to have a minor role in patients with chronic cough. Direct detection of Chlamydia pneumoniae by polymerase chain reaction on nasopharyngeal aspirates is highly correlated with detectable immunoglobulin M antibodies, but in the late stages of prolonged cough serological testing of immunoglobulin G and immunoglobulin A may be more beneficial for obtaining a microbiological diagnosis.     

Anti-actin antibodies of IgM and IgG class in chronic liver diseases detected by fluorometric immunoassay

Using a sensitive fluoroimmunoassay, anti-actin antibodies (AA) of the IgM and IgG classes were measured in 240 patients with various chronic liver diseases and in 211 patients with non-hepatic autoimmune muscle, heart, malignant and inflammatory bowel diseases. Thirty-two out of 40 patients (80%) with autoimmune chronic active hepatitis (CAH) had AA only of the IgG class (geom. mean X = 1.78, SEM +/- 0.07) and only three patients (8%) had both IgG and IgM AA, the latter in lower titres. In patients with primary biliary cirrhosis (PBC) and AMA-positive cholestatic CAH, AA of both IgM and IgG classes were equally represented (60% IgG and 64% IgM AA in PBC, 73% IgG and 51% IgM AA in cholestatic CAH) but the titres were very low (geom. mean IgG AA in PBC 1.035, SEM +/- 0.03, in cholestatic CAH 1.18, SEM +/- 0.02). In contrast to autoimmune (lupoid) CAH, AA were rare in HBsAg positive CAH (9/43, 21%) and only present in low titres. However, in six out of 21 patients with anti-HBs and anti-HBc-positive chronic active hepatitis, high AA of IgG class were found, suggesting the autoimmune type of liver disease. In NANB virus-induced chronic liver disease after blood transfusion, AA were only occasionally found (IgG antibodies 1/19, IgM antibodies 3/19) and none were found in the eight patients with sporadic NANB hepatitis. They were also rare in 30 patients with alcoholic liver disease (3/30, 10%).(ABSTRACT TRUNCATED AT 250 WORDS)     

肺炎衣原体与不稳定性心绞痛相关性的临床研究

目的　探讨肺炎衣原体感染与不稳定性心绞痛 (UAP)发病的关系。方法　UAP、稳定性心绞痛 (SAP)各 30例及正常对照组 2 0名。检测肺炎衣原体特异性抗体IgG、IgM滴度 ,肿瘤坏死因子α(TNFα)、C反应蛋白 (CRP)水平 ,组织型纤溶酶原激活剂 (tPA )及其抑制物 1(PAI 1)活性。结果　 (1)UAP组TNFα、CRP和PAI 1较SAP组和对照组升高 ;(2 ) 3组肺炎衣原体 IgG阳性率分别为 83.3%、6 0 %和 35 %,UAP组高于SAP组和对照组。IgM阳性率组间比较差异无显著性意义 ;(3)IgG阳性组TNFα、CRP、PAI 1及TG、TC、LDL C均显著高于阴性组 ,tPA低于阴性组。IgM阳性组和阴性组各参数比较差异无显著性意义。结论　肺炎衣原体慢性感染与UAP发生有关 ,其参与UAP的机制可能是 :肺炎衣原体感染诱导TNFα和CRP产生 ,促进PAI 1活性表达、降低tPA活性 ,并干扰血浆脂质代谢 ,从而促进UAP发生。     

Changes in antibody titers against Chlamydia pneumoniae after coronary angioplasty

OBJECTIVES: The potential role of common infectious agents in the pathogenesis and progression of atherosclerosis has been studied increasingly over the last decade. The evidence for Chlamydia pneumoniae as a potential causative agent is strong and is based on the findings of numerous sero-epidemiological studies, examination of atheromatous plaque specimens, in vitro animal models. We performed a prospective study in percutaneous transluminal coronary angioplasty (PTCA) patients to investigate whether the angioplasty procedure influenced the specific humoral immune response reaction against C. pneumoniae antigens. METHODS: We studied 76 patients who successfully underwent PTCA for de novo lesions. Blood samples were drawn immediately before PTCA and 1 month after PTCA. IgG and IgA antibodies against C. pneumoniae (strain CDC/CWL-029) were determined by an in-house developed enzyme immunoassay. RESULTS: At the time of angioplasty 75% and 34% of the patients had seropositive antibodies to elementary bodies (EBs) of classes IgG and IgA, respectively. Mean titers of IgG antibodies before and 1 month after PTCA were 46+/-31 and 50+/-28 relative units (RU/ml) (P>0.05). One month after PTCA, 97% and 34% of the patients had seropositive antibodies to EBs of classes IgG and IgA, respectively. We divided our patients into two groups on the basis of IgG seropositivity (group I: Chlamydia antibody IgG seronegative patients, group II: Chlamydia antibody IgG seropositive) before PTCA. Significant increase in the antibody titers of IgG (12+/-5 vs. 40+/-18, P<0.001) and IgA (0.6+/-0.33 vs. 1.15+/-0.83, P=0.007) was observed in group I patients 1 month after PTCA and 88% of them gained IgG seropositivity. There were no significant changes in IgG and IgA antibody levels in group II after PTCA. CONCLUSION: We have demonstrated a statistically significant rise in C. pneumoniae antibodies (especially IgG) induced by PTCA in patients previously seronegative.     

Chlamydia pneumoniae, herpes simplex virus and cytomegalovirus in symptomatic and asymptomatic high-grade internal carotid artery stenosis. Does infection influence plaque stability?

BACKGROUND: Current debates are focused on inflammatory processes in atherosclerotic lesions as a possible pathomechanism for destabilization and thrombembolism. In this prospective study the role of systemic and local infection in patients with high-grade internal carotid artery stenosis (ICA) was evaluated. PATIENTS AND METHODS: Serum antibody titers of 109 consecutive patients, who underwent surgery for ICA stenosis (asymptomatic n = 40, symptomatic n = 69) were prospectively measured for Chlamydia pneumoniae (Cpn) (IgA and IgG), Herpes simplex virus (HSV) (IgG, IgM) and Cytomegalovirus (CMV) (IgG, IgM) respectively. 53 carotis plaques of this group (asymptomatic n = 17, symptomatic n = 36) could be analyzed by polymerase chain reaction (PCR) for Cpn-, HSV- and CMV-DNA presence. RESULTS: Seropositivity was found in 61,5% for Cpn, 91,7% for HSV and 72,5% CMV respectively. No significant relation was found between symptomatic and asymptomatic patients as well as no difference was seen for presence of IgA antibodies against Cpn comparing both groups. Plaque-PCR revealed Cpn in 7 cases (13,2%), HSV in 2 cases (3,8%) and no CMV had been detected. Again, no significant relationship was found concerning symptomatic and asymptomatic patients. All 9 PCR-positive plaques displayed lesions of "complicated atherosclerosis" as central fibrous necrosis and calcification or plaque bleeding and surface thrombosis. CONCLUSIONS: Our results do not support the hypothesis that systemic Cpn, HSV or CMV- infection or evidence of Cpn-, HSV- or CMV-DNA in carotid plaques causes plaque destabilization and cerebral thromboembolism. Plaque infection could only be observed in cases with advanced atherosclerosis.     

Influence of Chlamydia pneumoniae and cytomegalovirus infections on prevalence and the course of coronary artery disease

Chlamydia pneumoniae (C. pneumoniae) as well as cytomegalovirus (CMV) are common pathogens found in about 50% of healthy western population. Many studies suggest a role of C. pneumoniae in development of coronary artery disease (CAD). CMV infection is also considered to increase risk of developing of CAD as well as restenosis after percutaneous coronary revascularization (PCI). The aim of our study was to evaluate a possible role of C. pneumoniae and CMV infections in both CAD development and course in patients (pts) undergoing PTCA. We enrolled 105 pts (mean age 56.4 years, 83 males) with angiographically documented CAD. Control group consisted of 63 healthy controls (mean age 47.25 years; 31 males). The study subjects were evaluated for presence of C. pneumoniae specific IgG antibodies (MIF test--MRL Diagnostic, USA; seroprevalence assumed when titre > or = 1/8). In 58 random PCI pts CMV specific IgG antibodies (ELISA Eti-Cytok-G PLUS--Dia Sorin) were evaluated. Pts were sampled at the time of PTCA. All PCI pts were assessed by angina questionnaire 5.9 +/- 2.6 months (mo) after the procedure with respect to clinical restenosis. C. pneumoniae IgG antibodies were detected in 37.1% of pts and in 22% of healthy controls (p < 0.05). After logistic regression was applied trend towards more frequent occurrence of C. pneumoniae specific IgG in CAD pts was shown (p = 0.10 OR = 2.4; 95% CI: 0.8-6.8). No significant correlation was found between anti-C. pneumoniae IgG presence or anti-CMV IgG titre and coronary atherosclerosis advancement. There was no significant difference in anti-CMV IgG titre between 9 pts who developed clinical restenosis 5.9 +/- 2.6 mo after PCI and the remaining pts. Our study results suggest a possible significant correlation between C. pneumoniae with CAD prevalence. We did not find a positive association of either infection markers with coronary atherosclerosis advancement. We did not find correlation of clinical restenosis after PCI with markers of CMV infection.     

The significance of Chlamydia pneumoniae in symptomatic carotid stenosis

An association between symptomatic carotid stenosis and recent infection with Chlamydia pneumoniae is reported. Thirty-five patients (20 symptomatic and 15 asymptomatic) with carotid stenosis of 70% to 90% underwent carotid endarterectomy. Endarterectomy was performed without patch and shunt; the average occlusion time of the internal carotid artery was 14 +/- 3 min. The atheromatic plaque and a portion of the thyroid artery were examined with polymerase chain reaction and peripheral vein blood was obtained for serologic detection of systematic infection, and IgG and IgM antibodies to C. pneumoniae by enzyme-linked immunosorbent assay. Twenty of 35 patients (57.1%) had increased titers of IgG antibodies to C. pneumoniae. Eight patients revealed IgG plus IgM antibodies; two of the eight had IgG, IgM, and positive findings on polymerase chain reaction. No C. pneumoniae was detected on the thyroid arteries. Sixty-five percent (13/20) of the patients with increased IgG antibodies to C. pneumoniae, 87.5% (7/8) with IgG + IgM, and 100% with IgG + IgM + positive polymerase chain reaction were symptomatic. Plaque morphology in association with symptoms did not reveal a significant correlation between soft plaques and symptoms, whereas the majority of the symptomatic patients had plaques of type III-V. Patients having recent contamination and positive polymerase chain reaction had a significant relationship between C. pneumoniae infection and symptomatic carotid disease. This supports the hypothesis that C. pneumoniae infection can produce a kind of instability of the carotid plaque. The results of this study demonstrate that patients with advanced atherosclerotic carotid disease have an increased incidence of C. pneumoniae infection. Recent infection could be responsible for instability of the carotid plaque, causing cerebral ischemic episodes.     

肺炎衣原体慢性感染对血脂水平的影响

目的探讨肺炎衣原体慢性感染对人血脂水平的影响。方法横断面研究方法;采用微量免疫荧光法检测血浆中肺炎衣原体特异性抗体,以肺炎衣原体IgA升高(滴度≥1∶32)的125名健康体检者为研究组,以性别、年龄近似但IgA抗体效价不升高(滴度<1∶32)的64名同期体检者为对照组,比较2组血清总胆固醇、甘油三酯水平的差异。结果研究组血清总胆固醇水平(4.28±0.74mmol/ml)高于对照组(4.01±0.74mmol/l),差异具有统计学意义(P<0.05),甘油三酯水平差别无统计学意义。血清总胆固醇水平与肺炎衣原体特异性抗体(IgG、IgM)、性别、年龄、家族史、吸烟史等因素无关。结论:肺炎衣原体慢性感染与血清总胆固醇水平升高密切相关。     

High prevalence of antibodies to calreticulin of the IgA class in primary biliary cirrhosis: a possible role of gut-derived bacterial antigens in its aetiology?

BACKGROUND: In a preliminary study we showed that antibodies to the endoplasmic reticulum protein calreticulin (CR) occur in primary biliary cirrhosis (PBC) and autoimmune hepatitis type 1 (AIH). Since anti-CR antibodies have also been found in patients with infectious diseases, we investigated their prevalence and immunoglobulin classes in patients with various hepatic and intestinal diseases, hoping to get some information on a possible relationship between an infectious trigger and the induction of a certain class of anti-CR antibodies. METHODS: Sera were tested for anti-CR antibodies of the IgA, IgG, and IgM class by Western blotting, using CR isolated from human liver: in autoimmune liver diseases (primary biliary cirrhosis (PBC) (n = 86) and autoimmune hepatitis (AIH) type 1 (n = 57)), alcoholic liver cirrhosis (ALC) (n = 32), viral liver infections (acute hepatitis A (n = 8), acute hepatitis B (n = 20), and chronic hepatitis C (n = 28)), and intestinal diseases (Crohn disease (CD) (n = 30), acute yersiniosis (n = 26)). Sera from 100 healthy individuals served as negative controls. RESULTS: The most prominent finding was the high prevalence of anti-CR antibodies of the IgA class and the similarity in the anti-CR antibody class pattern in PBC (IgA, 62%; IgG, 43%; IgM, 55%) and yersiniosis (IgA, 62%; IgG, 39%; IgM, 42%). Class IgA anti-CR antibodies also occurred frequently in ALC (IgA, 44%; IgG, 41%; IgM, 19%). In contrast, in AIH anti-CR antibodies were predominantly of class IgG (IgA, 28%; IgG, 60%; IgM, 33%). In hepatitis A anti-CR antibodies were absent. In the other diseases they had a low prevalence and were mostly of class IgG (acute hepatitis B: IgA, 0%; IgG, 15%; IgM, 0%; chronic hepatitis C: IgA, 7%; IgG, 21%; IgM, 0%; CD: IgA, 13%; IgG, 20%; IgM, 13%). Of the healthy individuals 7% had anti-CR antibodies exclusively of class IgG. CONCLUSIONS: The high prevalence of anti-CR antibodies of class IgA in patients with PBC and yersiniosis as well as in alcoholic liver disease reflects a reactivity of the gut-associated immune system and could imply that a still undefined gut-derived bacterial (?) agent may trigger PBC.     

Antibodies to Chlamydia pneumoniae in blood serum of patients with ischemic heart disease and presence of complicated lesions in coronary arteries

Levels of IgM, IgG and IgA antibodies to Chlamydia pneumoniae were measured in 107 patients (age 33-75 years) with documented coronary atherosclerosis and 39 subjects with intact coronary arteries. Rates of seropositivity to C. pneumoniae were 77.6 and 25.6% in patients and "healthy" subjects, respectively (p<0.05). Seropositive (n=83) compared with seronegative (n=24) patients had higher prevalence of complicated lesions (p<0.05).     

Increased frequency of Chlamydia pneumoniae antibodies in patients with asthma

The worldwide increase in asthma incidences and the impact of the disease on public health care have led to new investigations of the cause of the disease. Besides well-defined environmental causes, accumulating evidence suggests that respiratory tract infections play an important role in the pathogenesis of asthma. Among these microorganisms Chlamydia pneumoniae is an intracellular pathogen causing persistent infection. Chlamydia pneumoniae infection has been discussed as possibly inducing the development of asthma. This study was designed to investigate the presence of C. pneumoniae-specific IgG, IgA, and IgM antibodies in serum samples of 33 adults with a clinical history of asthma, positive methacholine test, and reduced FEV(1). Patients with asthma were compared with age-, sex-, and locality-matched control subjects (n = 33). We observed no acute infection either in patients with asthma or in control subjects, but 63% of all investigated individuals had signs of past infection. Chlamydia pneumoniae-specific IgA was detected in 52% of the patients with asthma and in 15% of the healthy control subjects (p < 0.01). Serological evidence of chronic infection with C. pneumoniae (high IgG [> pr = 1:512] and high IgA [> or = 1:40]) was more frequent in patients with asthma (18.2%) compared with control subjects (3.0%) (p < 0.01). Our results provide further evidence that chronic infection with C. pneumoniae is linked to asthma.