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目的探讨幽门螺杆菌(Helicobacter pylori,Hp)感染及其产生的毒力因子与急性冠脉综合征(ACS)的关系,并分析Hp感染对炎症反应以及血脂的影响。方法采用ELISA方法检测358例ACS患者和327例健康对照者血清中的Hp-IgG,用Western-blot方法检测血清抗CagA抗体以及抗VacA抗体。分析血中炎症反应标志物及血脂水平,比较合并Hp感染的ACS患者与非Hp感染者之间的差异。结果①ACS组Hp-IgG阳性率明显高于健康对照组(57.8%和44.3%,P<0.05),去除年龄、性别、吸烟、高血压、高脂血症以及糖尿病等危险因素后,Hp感染仍增加患ACS的危险性(OR=1.48,95%CI1.09~2.00)。②Ⅰ型Hp感染增加患ACS的危险性(OR=2.02,95%CI1.43~2.87),而中间型和Ⅱ型Hp感染并未明显增加患ACS的危险性。③合并Hp感染的ACS患者和健康对照者血清炎症反应物CRP、纤维蛋白原、白细胞以及血小板计数水平明显高于非Hp感染者(P<0.05)。④合并Hp感染的ACS患者和健康对照者TC、TG、LDL和Lp(a)水平均高于非Hp感染者,HDL低于非Hp感染者(P<0.05)。结论Hp感染是导致ACS的独立危险因素,Ⅰ型Hp感染可能更增加患ACS的危险性。Hp感染可能通过诱导全身炎症反应并影响脂质代谢而促进动脉粥样硬化的进展。
Objective To investigate the relationship between Helicobacter pylori (Hp) infection, the virulence factor and acute coronary syndrome (ACS) and the influence of Hp infection on inflammatory reaction and blood lipid. Methods The serum Hp-IgG in 358 ACS patients and 327 healthy controls was detected by ELISA. Serum anti-CagA antibody and anti-VacA antibody were detected by Western-blot. Blood samples were analyzed for inflammatory markers and blood lipids, and to compare the differences between ACS patients with and without H. pylori infection. Results ① The positive rate of Hp-IgG in ACS group was significantly higher than that in healthy control group (57.8% and 44.3%, P <0.05). After removing the risk factors of age, sex, smoking, hypertension, hyperlipidemia and diabetes, Increase the risk of ACS (OR = 1.48,95% CI1.09 ~ 2.00). ② Type I Hp infection increased the risk of ACS (OR = 2.02, 95% CI 1.43-2.87), while intermediate and type II Hp infection did not significantly increase the risk of ACS. ③ The serum levels of CRP, fibrinogen, white blood cells and platelets in Hp-infected ACS patients and healthy controls were significantly higher than those in non-Hp infected patients (P <0.05). ④ The levels of TC, TG, LDL and Lp (a) in Hp-infected ACS patients and healthy controls were higher than those in non-Hp infected patients and HDL was lower than that in non-Hp infected patients (P <0.05). Conclusion Hp infection is an independent risk factor for ACS. Type I Hp infection may increase the risk of ACS. Hp infection may promote the development of atherosclerosis by inducing systemic inflammatory response and affecting lipid metabolism.