The relationship between infection, inflammation, and cardiovascular disease: an overview.
The relationship between infection, inflammation, and cardiovascular disease: an overview.
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DOI：
10.1902/annals.2001.6.1.1
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发表时间：
2001-12-01
期刊：
影响因子：
--
通讯作者：
Lowe, G D
中科院分区：
文献类型：
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作者：
Lowe, G D
罗素·罗斯（Russell Ross）在组织学上将动脉粥样硬化斑块比作愈合的炎症性病变，他提出了一种“对损伤的反应”假说。最近，斑块内炎症被认为在纤维帽变薄、斑块破裂和血栓形成中起作用。血管损伤的潜在原因包括机械应力、烟雾暴露、高胆固醇血症、高同型半胱氨酸血症和慢性感染（直接或间接）。炎症标志物的血液水平（例如，C-反应蛋白[CRP];血清淀粉样蛋白A;纤维蛋白原;血浆粘度;红细胞沉降率[ESR]、白细胞计数、低血清白蛋白）与血管危险因素以及与普遍和偶发的动脉粥样硬化血栓形成性心血管疾病（CVD）（冠心病[CHD]、中风和外周动脉疾病）相关。最近，细胞因子（例如，白细胞介素-6 [IL-6]）和可溶性粘附分子（例如，细胞间粘附分子-1，血管细胞粘附分子-1）与危险因素和疾病有关;并为动脉疾病的非特异性“抗炎”治疗提供了潜在的治疗靶点。与动脉疾病相关的感染包括特异性感染（肺炎衣原体、幽门螺杆菌）和非特异性感染（牙周感染、呼吸道感染）。最近的荟萃分析表明，C。pneumoniae和H.幽门螺杆菌与动脉疾病，危险因素，或潜在的疾病的中介机制是弱于第一次提出的早期报告。同样，需要进一步的研究和荟萃分析来评估CVD与牙周感染和疾病以及慢性肺部感染和疾病的流行病学关系。慢性感染和CVD之间的关联越弱，建立（或排除）感染治疗的预防作用所需的随机对照试验的规模就越大。虽然控制口腔、胃或肺部的慢性感染适合其局部效应，但证明其预防CVD的有效性对医学科学提出了持续的挑战。
Atherosclerotic plaques were likened histologically to healing inflammatory lesions by Russell Ross, who proposed a "response to injury" hypothesis for their formation. More recently, intraplaque inflammation has been postulated to play a role in thinning of the fibrous cap, plaque rupture, and superadded thrombosis. Potential causes for vascular injury include mechanical stress, smoke exposure, hypercholesterolemia, hyperhomocysteinemia, and chronic infection (direct, or indirect). Blood levels of inflammatory markers (e.g., C-reactive protein [CRP]; serum amyloid A [SAA]; fibrinogen; plasma viscosity; erythrocyte sedimentation rate [ESR]; leukocyte count, low serum albumin) have been associated with vascular risk factors and with prevalent and incident atherothrombotic cardiovascular disease (CVD) (coronary heart disease, [CHD]; stroke; and peripheral arterial disease). More recently, cytokines (e.g., interleukin-6 [IL-6]) and soluble adhesion molecules (e.g., intercellular adhesion molecule-1, vascular cell adhesion molecule-1) have been associated with both risk factors and disease; and offer potential therapeutic targets for nonspecific "anti-inflammatory" treatment of arterial disease. Infections associated with arterial disease include specific infections (Chlamydia pneumoniae, Helicobacter pylori) and nonspecific infections (periodontal infections, respiratory tract infections). Recent meta-analyses have shown that associations of serum markers of C. pneumoniae and H. pylori with arterial disease, risk factors, or potential intermediary mechanisms for disease are weaker than was first suggested by early reports. Likewise, further studies and meta-analyses are required to evaluate the epidemiologic relationships of CVD to periodontal infection and disease and to chronic pulmonary infections and disease. The weaker the associations between chronic infections and CVD, the larger is the size of randomized controlled trials required to establish (or exclude) a preventive effect of infection treatment. While control of chronic infection in the mouth, stomach or lungs is appropriate for its local effects, proving its efficacy in prevention of CVD presents a continuing challenge to medical science.