Endovascular presence of viable Chlamydia pneumoniae is a common phenomenon in coronary artery disease
Endovascular presence of viable Chlamydia pneumoniae is a common phenomenon in coronary artery disease
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DOI：
10.1016/s0735-1097(98)00016-3
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发表时间：
1998-03-15
影响因子：
24
通讯作者：
Sievers, HH
中科院分区：
文献类型：
--
作者：
Maass, M;Bartels, C;Sievers, HH
目标。我们试图检查冠状动脉中是否存在挑剔的肺炎衣原体细菌。背景。呼吸道病原体肺炎衣原体与冠状动脉疾病（CAD）的发病机制有关。先前的研究已证明抗衣原体血清反应是心血管危险因素，并且冠状动脉粥样硬化斑块含有不同比例的衣原体成分。需要进行细菌复制的血管内演示，为 CAD 中的感染成分提供证据，并为讨论抗菌治疗提供依据。方法。对 70 名患者进行了心肌血运重建。对来自 53 个冠状动脉内膜切除术和 17 个再狭窄旁路样本的动脉粥样硬化病变进行培养，并进行肺炎衣原体的巢式聚合酶链反应 (PCR)。通过微量免疫荧光检查抗衣原体免疫球蛋白 G (IgG)、IgA 和 IgM。结果。从 70 个动脉粥样斑块中的 11 个（16%）中回收到活的肺炎衣原体，并在 70 个动脉粥样斑块中的 21 个（30%）中检测到衣原体脱氧核糖核酸（DNA）； 17 个非动脉粥样硬化对照样品 PCR 呈阴性 (p < 0.01)。 53 例动脉内膜切除术样本中的 15 例（28%）和 17 例旁路手术样本中的 6 例（35%）PCR 呈阳性。对六种不同 PCR 产物的 DNA 测序没有揭示冠状病毒分离株和呼吸道参考菌株之间的差异，这表明常见的呼吸道菌株可以进入体循环。血清学结果与直接检测结果不相关，并且不能识别个体血管内感染。结论。很大一部分动脉粥样硬化冠状动脉含有活的肺炎衣原体。这一发现支持了衣原体促进动脉粥样硬化形成的假设。衣原体是否引发动脉粥样硬化损伤、促进其进展或在动脉粥样硬化斑块上定居尚不清楚。然而，血管内存在活细菌证明了抗菌药物治疗在 CAD 治疗和预防中的益处的对照临床研究是合理的。 (C) 1998 年由美国心脏病学会发布。
Objectives. We sought to examine coronary arteries for the presence of viable bacteria of the fastidious species Chlamydia pneumoniae.Background. The respiratory pathogen C. pneumoniae has been implicated in the pathogenesis of coronary artery disease (CAD). Previous studies have demonstrated an antichlamydial seroresponse to be a cardiovascular risk factor and coronary atheromata to contain chlamydial components in varying proportions. Endovascular demonstration of replicating bacteria is required to provide evidence for an infectious component in CAD and a rationale to discuss antimicrobial therapy.Methods. Myocardial revascularization was performed in 70 patients. Atherosclerotic lesions from 53 coronary endarterectomy and 17 restenotic bypass samples were cultured and subjected to nested polymerase chain reaction (PCR) for C. pneumoniae. Antichlamydial immunoglobulin G (IgG), IgA and IgM was examined by microimmunofluorescence.Results. Viable C. pneumoniae was recovered from 11 (16%) of 70 atheromata, and chlamydial deoxyribonucleic acid (DNA) was detected in 21 (30%) of 70 atheromata; 17 nonatherosclerotic control samples were PCR-negative (p < 0.01). Fifteen (28%) of 53 endarterectomy and 6 (35%) of 17 bypass samples were PCR-positive. DNA sequencing of six different PCR products did not reveal differences between coronary isolates and respiratory reference strains, suggesting that common respiratory strains gain access to the systemic circulation. Serologic results did not correlate with direct detection results and did not identify individual endovascular infection.Conclusions. A significant proportion of atherosclerotic coronary arteries harbor viable C. pneumoniae. This finding supports the hypothesis of a chlamydial contribution to atherogenesis. Whether chlamydiae initiate atherosclerotic injury, facilitate its progression or colonize atheromata is unknown. However, the endovascular presence of viable bacteria justifies a controlled clinical investigation of antimicrobial treatment benefit in the therapy and prevention of CAD. (C) 1998 by the American College of Cardiology.