【摘要】 目的 探讨肺炎衣原体（chlamydia pneumoniae,CPn）感染与急性冠脉综合征（acute coronary syndrome,ACS）的关系。方法 选取2017年8月至2018年1月期间于大连医科大学附属第二医院心内科以“胸痛”为主诉入院的患者共124例。依据心肌酶、心电图变化、冠脉造影检查明确诊断为ACS者84例（ACS组），上述检查结果均为阴性者40例（对照组）。收集所有患者一般临床资料、生化及心脏彩超检查结果，测定血清IL-6、TNF-α、CPn-IgG、CPn-IgM抗体及其滴度水平，比较两组间的差异。将ACS组进一步分为CPn-IgG阳性组及CPn-IgG阴性组，比较两组TC、TG、LDL、HDL水平，并对ACS的危险因素进行分析。结果 （1）ACS组CK-MB、CTNI、proBNP、TC、LDL、AST、WBC、NEUT、hs-CRP、Fbg、IL-6显著高于对照组，HDL显著低于对照组，差异有统计学意义（P<0.05）。（2）ACS组CPn-IgG阳性率及滴度水平高于对照组，差异有统计学意义（P<0.05）。而两组间CPn-IgM阳性率及滴度水平比较，差异无统计学意义（P> 0.05）。（3）CPn-IgG阳性组TC、 LDL显著高于CPn-IgG阴性组，HDL显著低于CPn-IgG阴性组，差异有统计学意义（P<0.05）。而两组患者TG水平无明显差异（P> 0.05）。（4）多因素logistic回归分析显示CPn-IgG(OR=3.185, 95%CI 1.447～7.012)、 hs-CRP(OR=1.172,95%CI 1.013～1.356)、 LDL(OR=1.954, 95%CI 1.076～3.550)、 HDL(OR=0.127, 95%CI 0.018～0.912)、 TC(OR=1.983,95%CI 1.197～3.286)是ACS的独立危险因素（P<0.05）。结论 CPn慢性感染与ACS的发生密切相关。CPn感染后可能通过激活炎症反应、影响血脂代谢，导致ACS的发生。更多还原

【Abstract】 Objective To investigate the relationship between chlamydia pneumonia(CPn) infection and acute coronary syndrome(ACS). Methods A total of 124 patients admitted to the Department of Cardiovascular Medicine of the Second Affiliated Hospital of Dalian Medical University with "chest pain" as chief complaint from August 2017 to January 2018 were selected. Among them, 84 patients were diagnosed with ACS according to the myocardial enzymes, ECG changes and coronary angiography. There were 43 cases of acute myocardial infarction(AMI) and 41 cases of unstable angina pectoris(UA). The remaining 40 patients with negative results were included in the control group. The general clinical data, biochemical and cardiac ultrasonography results of all enrolled patients were collected. Serum IL-6, TNF-α, CPn-IgG and CPn-IgM antibodies and their titers were measured. The differences between the two groups were compared. The ACS group was further divided into CPn-IgG positive and negative subgroups. TC, TG, LDL and HDL were determined in the two groups. And the risk factors of ACS were analyzed. Results(1) The CK-MB, CTNI, proBNP, TC, LDL, AST, WBC, NEUT, hs-CRP, Fbg, IL-6 levels in the ACS group were significantly higher than those in the control group, while HDL level was significantly lower than that in the control group(P< 0.05).(2) The CPn-IgG positive rate and titer in ACS group were higher than those in control group(P<0.05). There were no significant differences in CPn-IgM antibody positive rate and titer between the two groups(P>0.05).(3) The levels of TC and LDL in CPn-IgG positive subgroup were significantly higher than those in CPn-IgG negative subgroup.The HDL level in CPn-IgG positive subgroup was significantly lower than that in CPn-IgG negative subgroup(P<0.05). There was no significant difference in TG level between the two subgroups(P> 0.05).(4) Multivariate logistic regression analysis revealed that CPn-IgG(OR=3.185, 95%CI 1.447-7.012), hs-CRP(OR=1.172, 95%CI 1.013-1.356), LDL(OR=1.954, 95%CI 1.076-3.550), HDL(OR=0.127, 95%CI 0.018-0.912), TC(OR=1.983, 95%CI 1.197-3.286) were independent risk factors for ACS(P<0.05). Conclusion Chronic infection of CPn is closely related to ACS. CPn infection may contribute to the development of ACS by activating the inflammatory response and affecting lipid metabolism.更多还原