Urinary tract infection in patients with acute coronary syndrome: A potential systemic inflammatory connection
Urinary tract infection in patients with acute coronary syndrome: A potential systemic inflammatory connection
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DOI：
10.1016/j.ahj.2004.08.043
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发表时间：
2005-06-01
影响因子：
4.8
通讯作者：
McGuire, DK
中科院分区：
文献类型：
--
作者：
Sims, JB;de Lemos, JA;McGuire, DK
背景 炎症与动脉粥样硬化疾病的发展和不稳定有关。导致全身炎症的因素，例如亚临床感染，可能会引发急性冠状动脉综合征 (ACS)。 方法 采用病例对照研究设计，我们评估了 100 名连续 ACS 患者中尿路感染 (UTI) 的患病率，并与接受择期冠状动脉旁路移植术 (CABG) 手术的当代对照组进行比较。如果未通过图表审查确认 ACS 或未获得尿液分析，则排除病例：！ 6小时抵达。对照组中排除的患者为CABG前21天内患有心肌梗死（MI）或未进行CABG前尿液分析的患者。 结果 病例组和对照组匹配良好，唯一显着差异是CABG对照组充血性心力衰竭较少（OR 7.3，95% CI 3.3-15.9）和既往MI较多（OR 0.5，95% CI 0.3-0.9）。 27 例 ACS 病例和 1 例对照病例存在 UTI。在ACS病例中，患有UTI的患者往往年龄较大，且女性较多，糖尿病、高脂血症、高血压和肾功能不全者较多，非ST段抬高型心肌梗死更常见。在未经调整的分析中，病例中 UTI 的发生率是对照组的 3 倍（OR 3.0，95% Cl 1.4-6.4）；多变量调整后结果相似（OR 3.0，95% Cl 1.3-6.8）。 结论 亚临床 UTI 在 ACS 患者中很常见。潜在感染可能通过激活全身炎症而引发 ACS。应在其他数据集中探索这一假设，并应检查与其他细菌和病毒感染的类似关系。
Background Inflammation has been linked with atherosclerotic disease development and instability. Contributors to systemic inflammation, such as subclinical infection, may trigger acute coronary syndromes (ACSs).Methods Using a case-control study design, we evaluated the prevalence of urinary tract infection (UTI) among 100 consecutive ACS patients, compared with a contemporary control group undergoing elective coronary artery bypass graft (CABG) surgery. Cases were excluded if ACS was not confirmed by chart review or if a urinalysis was not obtained :! 6 hours of arrival. Patients excluded from the control group were those with myocardial infarction (MI) within 21 days before CABG or without a pre-CABG urinalysis.Results The case and control groups were well matched, with the only significant differences being less congestive heart failure (OR 7.3, 95% CI 3.3-15.9) and more prior MI (OR 0.5, 95% CI 0.3-0.9) in the CABG control group. UTI was present in 27 of the ACS cases and I I of the controls. Among ACS case patients, those with UTI tended to be older and more often women, with more diabetes, hyperlipidemia, hypertension, and renal insufficiency, and more commonly had non-ST elevation MI. In unadjusted analysis, UTI was 3 times more common in the cases versus controls (OR 3.0, 95% Cl 1.4-6.4); results were similar after multivariable adjustment (OR 3.0, 95% Cl 1.3-6.8).Conclusions Subclinical UTI is common among patients with ACS. Underlying infection may precipitate ACS via activation of systemic inflammation. This hypothesis should be explored in other data sets, and similar relationships with other bacterial and viral infections should be examined.