幽门螺旋杆菌感染是冠心病的危险因素

（北京武警总医院 韩玮 翻译）

H. Pylori Infection Shown to Be a CAD Risk Factor

TCT 2008发布的一篇摘要指出，幽门螺旋杆菌是造影证实冠心病的独立危险因素。孟加拉达卡国立心血管研究所的Afzalur Rahman和同事研究了144例可疑冠心病或确诊冠心病（冠状动脉狭窄超过50％）行冠状动脉造影的患者，80例为冠心病，64例无冠心病（对照组）。

作者采用酶联免疫法测定抗幽门螺旋杆菌IgG抗体、C反应蛋白和血栓素水平，采用Western Blot法检测幽门螺旋杆菌细胞毒素(cag A)相关蛋白和幽门螺旋杆菌空泡毒素(vac A)抗原，冠心病组52例（65%）和对照组32例（50%）幽门螺旋杆菌阳性。

Logistic回归分析显示，糖尿病(P = .013)、vac-A阳性幽门螺旋杆菌感染(P = .049)是冠心病的独立危险因素，另外独立分析显示vac-A 阳性幽门螺旋杆菌感染和高血糖(P = .047)、高CRP(P = .05)和血栓素水平(P = .049)显著相关。Rahman说，“该研究发现迫切需要采取措施做好冠心病的一级和二级预防。Vac-A阳性幽门螺旋杆菌抗体治疗可能降低冠心病发展的危险，尤其是在高危患者群中，但还需要临床试验的证实。”

感染和冠心病

Rahman说，“有很多关于感染和冠心病关系的研究，但结果不一。但并没有对两个重要的致病因子vac-A和cag-A进行研究，我们的研究发现了vac-a在冠心病中起作用，而cag-a则没有作用。”该研究强调将炎症和感染作为冠状动脉粥样硬化的重要组成部分，“高危人群中一定要打断这一传播链。”

（来源：www.tctmd.com）

H. Pylori Infection Shown to Be a CAD Risk Factor

By TCT Daily Staff

Helicobacter pylori infection is an independent predictor of angiographically defined coronary artery disease (CAD), according to an abstract presented at TCT 2008.

Afzalur Rahman, MD, PhD, of the National Institute of Cardiovascular Diseases in Dhaka, Bangladesh, and colleagues studied 144 patients who underwent coronary angiography for suspected or known CAD (coronary arterial narrowing >50%). Eighty patients had CAD; 64 did not (control group).

Using enzyme immunoassay, they measured levels of anti-H. pylori IgG antibody, C-reactive protein, and thromboxane. In addition, a Western Blot test was used to detect H. pylori cytotoxin-associated (cag A) protein and H. pylori vacuolization (vac A) cytotoxin antigen. A total of 52 (65%) patients with CAD and 32 (50%) control group patients were seropositive for H. pylori.

According to logistic regression analysis, diabetes mellitus (P = .013) and vac-A-positive H. pylori infection (P = .049) were independent predictors of CAD. Furthermore, in a separate analysis, vac-A-positive H. pylori infection was found to be strongly linked to higher fasting plasma glucose (P = .047), serum CRP (P = .05), and thromboxane levels (P = .049).

"The study findings have immense potential for primary and secondary prevention of CAD," Rahman said in an interview.

"Antibiotic treatment of subjects with vac-A-positive H. pylori infection may reduce the risk of the development or progression of CAD, particularly in certain high-risk populations in endemic areas," he explained. "But that needs to be established by clinical trials."

Infection and CAD

"The link between the particular bacterial infection and CAD has been widely studied with mixed results," Rahman said. "But the role of two important virulence factors − vac A and cag A − produced by the bacterium, has not been studied in angiographically defined CAD. This study finds a role of vac A and negates any role of cag A in CAD."

These findings highlight the growing recognition of infection and inflammation as a potentially critical component of atherosclerosis, according to Rahman. "The chain of transmission must be broken, particularly in high-risk populations," he said, adding that public health initiatives on personal hygiene could play an important part in achieving this goal.