Hala Awadalla, Salah ELDEMERDASH, Maha Ezz El DIN, Hesham Abo El NAGA

Akut koroner sendrom gelişiminde enfeksiyonun rolü

AMAÇ: Enfeksiyon ajanlar ve ateroskleroz arasında potansiyel bir ilişki öngörülmektedir. Bir çok seroepidemiyolojik çalışmadan elde edilen veriler Chlamydophila pneumoniae, Helicobacter pylori ve Cytomegalovirus enfeksiyonlarının ateroskleroz sürecini başlattığı veya sürdürdüğünü desteklemektedir. Bu çalışmanın amacı bazı enfeksiyon ajanlarının serum titreleri ve akut koroner sendrom arasındaki olası ilişkileri incelemek, ve bu enfeksiyon ajanları ile diğer akut koroner sendrom risk faktörleri arasındaki ilişkiyi (sigara, hipertansiyon, dislipidemi, diyabet ve ailede koroner kalp hastalığı öyküsü) değerlendirmektir. YÖNTEM: Bu, hastane tabanlı vaka-kontrol çalışması iki grup üzerinde yapıldı: 86 hastayı içeren vaka grubu hastaları Ain Sham Üniversites, Cleopatra Hastanesi, kardiyolojik bakım ünitesinde, Ocak-Haziran 2010 tarihleri arasında, miyokard enfarktürü nedeniyle tedavi gören hastaları arasından seçildi ve kontrol grubu 86 sağlıklı bireyi içermekteydi. Geleneksel koroner risk faktörlerini değerlendirmek üzere bir soru formu tasarlandı. Chlamydia pneumoniae, Cytomegalovirus ve Helicobacter pylori IgG seroprevalansları niceliksel ELISA yöntemi ile değerlendirildi. BULGULAR: Sonuçlar, akut koroner sendrom hastalarının kontroller ile karşılaştırıldığında C. pneumoniae, Cytomegalovirus ve Helicobacter pylori IgG serum antikor düzeylerinde yükselme gösterdi. TARTIŞMA: C. pneumoniae, Cytomegalovirus ve Helicobacter pylorinin serum IgG antikor düzeylerindeki anlamlı artış, koroner arter hastalığının bir belirleyicisi olarak beklenebileceğini göstermektedir.

[The role of infection in the development of acute coronary syndrome]

AIM: A potential link between infectious agents and atherosclerosis has been suggested. Data obtained from several seroepidemiological studies have suggested that infection with Chlamydophila pneumoniae, Helicobacter pylori, and Cytomegalovirus can initiate or maintain the atherosclerotic process. To evaluate the probable relationship between serum titers of some various infectious agents and the development of acute coronary syndrome and to investigate the relationship between these infectious agents and other risk factors of acute coronary syndrome (smoking, hypertension, dyslipidemia, diabetes, and family history of CVD) METHOD: This is a hospital based case- control study was conducted on two groups: patients group included 86 patients, cases were collected from patients admitted to Cardiac Care Unit (CCU) of Cleopatra hospital, and Ain Shams University hospital with acute myocardial infarction between January 2010 and June 2010 and control group included 86 apparently healthy individuals. A questionnaire was designed to determine conventional coronary artery risk factors. The sero-prevalence of Chlamydia pneumoniae (C. pneumoniae), Cytomegalovirus and Helicobacter pylori (H. pylori) IgG antibodies were evaluated using quantitative enzyme-linked immunosorbent assay (ELISA). RESULTS: The results showed that there was an increased level of serum IgG antibodies of C. pneumoniae, Cytomegalovirus and Helicobacter pylori among patients with acute coronary syndrome compared to control subjects CONCLUSION: C. pneumoniae, Cytomegalovirus and Helicobacter pylori were expected to be predictors for the development of coronary artery disease, as there was significant elevation of the serum level of IgG antibodies against them.

PDF

___

1. He J, Gu D, Wu X. Major causes of death among men and women in China. N Engl J Med. 2005; 353: 1124.
2. Oemrawsingh RM, Akkerhuis KM, Boersma E. Tailor-made therapy for the prevention of acute coronary syndromes: future role of biomarkers in risk stratification and disease management. Expert Rev Cardiovasc Ther. 2008; 6(4): 435-437.
3. Goldschmidt PJ, Creager MA, Lorsordo DW, Lam GKW, Wassef M, Dzau VJ. Atherosclerosis, recent discoveries and novel hypotheses. Circulation. 2005; 112(21): 3348-3353.
4. Libby P, Theroux P. Pathophysiology of coronary artery disease. Circulation. 2005; 111: 3481.
5. Harskamp RE, van Ginkel MW. Acute respiratory tract infections: a potential trigger for the acute coronary syndrome. Ann Med. 2008; 40(2): 121-128.
6. Epstein SE, ZhuJ, Najafi AH, Burnett MS. Insights into the role of infection in atherogenesis and in plaque rupture. Circulation. 2009; 119(24): 3133-3141.
7. Jha HC, Srivastava P, Divya A, Prasad J, Mittal A. Prevalence of Chlamydophila pneumoniae is higher in aorta and coronary artery than in carotid artery of coronary artery disease patients. APMIS. 2009; 117(12): 905- 911.
8. Zadegan SN, Rezaporian P, Kaypour M, et al. Prognostic value of infection and inflammation markers for late cardiac events in an Iranian sample. Eastern Mediterranean Health Journal. 2008; 14(6): 1246-1256.
9. Maia IL, Nicolau JC, Machado Mde N, et al. Prevalence of Chlamydia pneumoniaee and Mycoplasma pneumoniae in different forms of coronary disease. Arq Bras Cardiol. 2009; 92(6): 405-411, 422-4288, 439-445.
10. Corrales-Medina VF, Madjid M, Musher DM. Role of acute infection in triggering acute coronary syndromes. Lancet Infect Dis. 2010; 10(2): 83-92.
11. Watson KE. The relationship between Inflammation and Atherosclerosis. Rev. Cardiovasc Med. 2004; 5(1): 66-68.
12. Jha HC, Prasad J, Mittal A. High immunoglobulin A seropositivity for combined Chlamydia pneumoniae, Helicobacter pylori infection, and high-sensitivity C-reactive protein in coronary artery disease patients in India can serve as atherosclerotic marker. Heart Vessels. 2008; 23(6): 390-396.
13. Pesonen E, Tiirola T, Andsberg E, et al. Serum chlamydial lipopolysaccharide as a prognostic factor for a new cardiovascular event. Heart Lung. 2009; 38(3): 176-181.
14. Sawayama Y, Kikuchi K, Tatsukawa M, et al. Association of Chlamydophila pneumoniae DNA in peripheral blood mononuclear cells and IgA antibody with atherosclerotic diseases. Fukuoka Igaku Zasshi. 2009; 100(9): 305-312.
15. West SK, Kohlhepp SJ, Jin R, Gleaves CA, Stamm W, Gilbert DN. Detection of circulating Chlamydophila pneumoniae in patients with coronary artery disease and healthy control subjects. Clin Infect Dis. 2009; 48(5) :560- 567.
16. Karimi M, Nough H, Lotfi M, et al. Evaluation of antichlaymdia pneumonia antibody in patients with coronary artery disease. Indian journal of community medicine. 2006; 31(4): 226-229.
17. Gupta S, Leatham EW, Carrington D, et al. Elevated Chlamydia pneumoniae antibodies, cardiovascular events, and azithromycin in male survivors of myocardial infarction. Circulation. 1997; 96: 404-407.
18. Gattone M, Lacoviello L, Colombo M, Castelnuovo A, Soffiantino F, Gramoni A. Chlamydia pneumoniae and Cytomegalovirus seropositivity, inflammation marker and the risk of myocardial infarction at young age. Am.heart J. 2001; 142(4): 633-640.
19. Hiroyuki O, Masanobu K, Mikihisa F, et al. Helicobacter pylori infection and coronary heart disease in Japanese patients. Cardiology. 2001; 95(1): 14-19.
20. Fakhry M, Al-Quorain A, Al-Khadra A, et al. The role of Helicobacter pylori infection in coronary artery disease In Saudi Arabia. The Egyptian Heart Journal. 2004; 56(4): 481- 485.
21. Vcev A, Nakić D, Mrden A, et al. Helicobacter pylori infection and coronary artery disease. Coll Antropol. 2007; 31(3): 757-760.
22. Awadalla HI, Ragab MH, Hanna LN. Environmental risk factors affecting transmission of Helicobacter pylori infection in Egypt. J public health. 2010; 18(3): 237- 244.
23. Basinkevich AB, Shakhnovich RM, Martynova VR, Kolkova NI, Rakovskaia IV, Karazhas NV. [Role of Chlamydia, mycoplasma and Cytomegalovirus infection in the development of coronary artery disease] Kardiologiia. 2003; 43(11):4-9.
24. Gredmark S, Jonasson L, Van Gosliga D, Ernerudh J, Söderberg-Nauclér C. Active cytomegalovirus replication in patients with coronary disease. Scand Cardiovasc J. 2007; 41(4): 230-234
25. Robert B., Thomas W, Band E. Cytokmegalovirus seropositivity infection burden and coronary heart disease. Am Heart J. 2003; 145(2): 375-377.
26. Blum A, Peleg A, Weinberg M. Anti- Cytomegalovirus IgG antibody titer in patients with risk factors to atherosclerosis. J. of clinical and experimental medicine. 2003; 3:157-160.
27. Cai XJ, Cai HB, Lu D. Study on the correlation of between infection, inflammation and coronary artery disease. Zhonghua Liu Xing Bing Xue Za Zhi. 2003; 24(6): 503-507.