The association of prior cytomegalovirus infection with neovascular age-related macular degeneration.
The association of prior cytomegalovirus infection with neovascular age-related macular degeneration.
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DOI：
10.1016/j.ajo.2004.03.018
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发表时间：
2004-09-01
影响因子：
4.2
通讯作者：
Cousins, SW
中科院分区：
文献类型：
--
作者：
Miller, DM;Espinos-Heidmann, DG;Cousins, SW
目的：确定先前暴露于与血管疾病、巨细胞病毒、肺炎衣原体和幽门螺杆菌相关的病原体是否与新生血管性年龄相关性黄斑变性（AMD）相关。设计：实验研究。方法:设置:制度。2001年10月至2002年12月，巴斯科姆帕尔默眼科研究所。患者群体：150例患者（47例新生血管性AMD， 36例干性AMD， 67例非AMD对照）纳入研究。排除标准包括HIV感染、恶性肿瘤、近期需要在6个月内住院治疗的急性疾病或免疫抑制疾病。操作步骤：采集血清样本，用ELISA法检测巨细胞病毒、肺炎衣原体和幽门螺杆菌IgG抗体滴度。主要观察指标：湿性AMD患者、干性AMD患者和对照组之间IgG滴度分布的比较。结果：湿性AMD患者的巨细胞病毒IgG平均滴度高于对照组（p = 0.02，学生t检验，2，尾）和干性AMD患者（p = 0.06）。47例湿性AMD患者中有26例（55%）巨细胞病毒IgG滴度高，而36例干性AMD患者中有14例（39%）（比值比[OR] = 2.23, 95%可信区间[CI] = 0.77 ~ 6.44）和67例对照患者中有23例（34%）（OR = 2.49, 95% CI = 0.98 ~ 6.33）。湿性和干性AMD患者肺炎衣原体IgG和幽门螺杆菌IgG滴度分布无明显差异。47例湿性AMD患者中有5例（11%）对所有三种病原体具有高抗体滴度，而36例干性AMD患者中只有1例（3%）（OR = 4.17, 95% CI = 0.46至37.36）。结论：与干性AMD和对照患者相比，巨细胞病毒IgG滴度高与新生血管性AMD存在显著相关性。巨细胞病毒慢性感染可能是干性AMD发展为新生血管性AMD的一个新的危险因素。
PURPOSE: To determine if prior exposure to pathogens associated with vascular disease, cytomegalovirus, Chlamydia pneumoniae, and Helicobacter pylori correlates with neovascular age-related macular degeneration (AMD).DESIGN: An experimental study.METHODS:SETTING: Institutional. Bascom Palmer Eye Institute, October 2001 to December 2002.PATIENT POPULATION: 150 patients (47 neovascular AMD, 36 dry AMD, and 67 non-AMD controls) were included in the study. Exclusion criteria included HIV infection, malignancy, recent acute illness requiring hospitalization within 6 months, or immunosuppressive illness.PROCEDURE: Serum samples were obtained for analysis of cytomegalovirus, Chlamydia pneumoniae, and Helicobacter pylori IgG antibody titers by ELISA.MAIN OUTCOME MEASURE: Comparison of the distribution of IgG titers between patients with wet AMD, dry AMD, and controls.RESULTS: The average cytomegalovirus IgG titer was higher in patients with wet AMD versus controls (p = 0.02, Student t-test, two,tailed) and patients with dry AMD (p = 0.06). Twenty,six (55%) of 47 subjects with wet AMD had high cytomegalovirus IgG titers compared with 14 (39%) of 36 patients with dry AMD (odds ratio [OR] = 2.23, 95% confidence interval [CI] = 0.77 to 6.44) and 23 (34%) of 67 control patients (OR = 2.49, 95% CI = 0.98 to 6.33). There was no major difference in the distribution of titers for Chlamydia pneumoniae IgG and Helicobacter pylori IgG in wet and dry AMD patients. Five of 47 patients with wet AMD (11%) had high antibody titers to all three pathogens, compared with only 1 of 36 patients with dry AMD (3%) (OR = 4.17, 95% CI = 0.46 to 37.36).CONCLUSIONS: There was a significant association of high cytomegalovirus IgG titer with neovascular AMD compared with dry AMD and control patients. Chronic infection with cytomegalovirus may be a novel risk factor for the progression from dry to neovascular AMD.