【摘要】 目的探讨幽门螺杆菌(Helicobacter pylori,Hp)感染及其产生的毒力因子与急性冠脉综合征(ACS)的关系,并分析Hp感染对炎症反应以及血脂的影响。方法采用ELISA方法检测358例ACS患者和327例健康对照者血清中的Hp-IgG,用Western-blot方法检测血清抗CagA抗体以及抗VacA抗体。分析血中炎症反应标志物及血脂水平,比较合并Hp感染的ACS患者与非Hp感染者之间的差异。结果①ACS组Hp-IgG阳性率明显高于健康对照组(57.8%和44.3%,P<0.05),去除年龄、性别、吸烟、高血压、高脂血症以及糖尿病等危险因素后,Hp感染仍增加患ACS的危险性(OR=1.48,95%CI1.09~2.00)。②Ⅰ型Hp感染增加患ACS的危险性(OR=2.02,95%CI1.43~2.87),而中间型和Ⅱ型Hp感染并未明显增加患ACS的危险性。③合并Hp感染的ACS患者和健康对照者血清炎症反应物CRP、纤维蛋白原、白细胞以及血小板计数水平明显高于非Hp感染者(P<0.05)。④合并Hp感染的ACS患者和健康对照者TC、TG、LDL和Lp(a)水平均高于非Hp感染者,HDL低于非Hp感染者(P<0.05)。结论Hp感染是导致ACS的独立危险因素,Ⅰ型Hp感染可能更增加患ACS的危险性。Hp感染可能通过诱导全身炎症反应并影响脂质代谢而促进动脉粥样硬化的进展。更多还原

【Abstract】 Objective To investigate the association between acute coronary syndrome(ACS)and Helicobacter pylori infection.To evaluate the effects of H.pylori infection on the serum levels of lipid concentrations and inflammatory parameters.Methods H.pylori IgG antibodies were assessed by ELISA in 358 patients with ACS and 327 controls.Cytotoxin associated protein A(CagA)and VacA proteins were tested by Western-blot assay in the patients with H.pylori seropositivity.Plasma inflammatory parameters and lipid concentrations were measured.Results Prevalence of H.pylori IgG was higher in ACS patients than in controls(57.8% vs 44.3%,P<0.05),the H.pylori seropositivity was associated with ACS(OR=1.72,95%CI 1.27～2.33).The association was still seen(OR=1.48,95%CI 1.09～2.00)excluding age,gender,smoking,hypertension,hyperlipemia and diabetes.ACS patients also had a higher prevalence of CagA and VacA positive H.pylori strains(40.5% vs 23.5%),and adjusted odds ratio was 2.02(95%CI 1.43～2.87).Inflammatory parameters and lipids concentrations were significantly higher in H.pylori positive subjects than in H.pylori negative subjects.Conclusion H.pylori seropositivityis an independent risk factor for ACS,infection with CagA and VacA positive strains appear to be more related to the disease.The increased systemic inflammatory parameters and lipids concentration in ACS patients seem to be related to H.pylori seropositivity.更多还原