肺炎衣原體感染和腦梗死關系的Meta分析_《中國循證醫學雜志》

作者：

于亮 ^1,2 , 白雙蓮 ³ ,  佟偉軍 ¹

1. 蘇州大學醫學部放射醫學與公共衛生學院（蘇州?215123）；2. 無錫市婦幼保健院（無錫?214001）；3. 內蒙古通遼市科左后旗疾病預防控制中心（通遼?028000）;

關鍵詞：

腦梗死肺炎衣原體 Meta分析感染

DOI：

10.7507/1672-2531.20090151

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目的　探討肺炎衣原體（chlamydia pneumoniae，CP）感染和腦梗死的關系。
方法　計算機檢索MEDLINE、BIOSIS、重慶維普期刊數據庫和中國期刊全文數據庫，按納入和排除標準收集研究CP和腦梗死關系的病例對照研究。檢索時間范圍為1990年1月至2007年12月。評價納入研究質量后，采用RevMan 4.2軟件進行Meta分析。
結果　共納入22個研究。Meta分析結果顯示：① 以微量免疫熒光（MIF）法檢測CP抗體，當以IgA≥1?16為截斷值時，腦梗死組CP血清學陽性率明顯高于對照組［n=8，OR?=2.18，95%CI（1.49，3.49）］；以IgA≥1?32為截斷值時，兩組CP血清學陽性率差異無統計學意義［n=3，OR=1.47，95%CI（0.97，2.24）］；以IgG≥1?32［n=6，OR=1.24，95%CI（0.82，1.86）］和 IgG≥1?64［n=5，OR=1.23，95%CI（0.98，1.55）］為截斷值時，兩組CP血清學陽性率差異均無統計學意義；② 以ELISA法檢測CP-IgG抗體，腦梗死組CP血清學陽性率明顯高于對照組［n=8，OR=2.40，95%CI（1.42，4.06）］；③ CP急性感染［n=4，OR= 7.22，95%CI（2.68，19.49）］和慢性感染［n=4，OR=4.30，95%CI（3.40，7.40）］均與腦梗死的發病相關。
結論　① CP感染和腦梗死發病的相關性因血清陽性標準而異，采用血清IgA抗體為檢測指標比IgG抗體更敏感，以血清IgA抗體滴度≥1?16為陽性判斷標準時，顯示CP感染和腦梗死相關；② 以ELISA法檢測CP-IgG抗體提示，CP感染和腦梗死相關，且結果穩定性較好；③ CP急性和慢性感染均與腦梗死相關，但尚需大樣本、科學設計的流行病學研究來進一步證實。

引用本文： 于亮,白雙蓮,佟偉軍. 肺炎衣原體感染和腦梗死關系的Meta分析. 中國循證醫學雜志, 2009, 09(8): 855-861. doi: 10.7507/1672-2531.20090151 復制

1.	Chiu B, Vim E, Tucker W, et a1. Chlamydia pneumoniae, cytomegalovirus, and herpes simplex vires in atherosclerosis of the carotid artery. Circulation, 1997, 96: 2144-2148.
2.	Pellicano R. Is there an association between Helicobacter pylori infection and coronary heart disease? Eur Jor of Epi, 1999, 15(7): 611-619.
3.	Wimmer ML, Sandmann-Strupp R, Saikku P, et al. Association of chlamydial infection with cerebrovascular disease. Stroke, 1996, 27(12): 2207-2210.
4.	Cook PJ, Honeybourne D, Lip GY, et al. Chlamydia pneumoniae antibody titers are significantly associated with acute stroke and transient cerebral ischemia: the West Birmingham Stroke Project. Stroke, 1998, 29(2): 404-410.
5.	Glader CA, Stegmayr B, Boman J, et al. Chlamydia pneumoniae antibodies and high lipoprotein(a) levels do not predict ischemic cerebral infarctions. Results from a nested case-control study in Northern Sweden. Stroke, 1999, 30(10): 2013-2018.
6.	Elkind MS, Lin IF, Grayston JT, et al. Chlamydia pneumoniae and the risk of first ischemic stroke: The Northern Manhattan Stroke Study. Stroke, 2000, 31(7): 1521-1525.
7.	Heuschmann PU, Neureiter D, Gesslein M, et al. Association between infection with Helicobacter pylori and Chlamydia pneumoniae and risk of ischemic stroke subtypes: Results from a population-based case-control study. Stroke, 2001, 32(10): 2253-2258.
8.	Madre JG, Garcia JL, Gonzalez RC, et al. Escribano JR. Martinez JD. Cenjor RF. Association between seropositivity to Chlamydia pneumoniae and acute ischaemic stroke. European Journal of Neurology, 2002, 9(3): 303-306.
9.	Kawamoto R, Kajiwara T, Oka Y, et al. An association between an antibody against Chlamydia pneumoniae and ischemic stroke in elderly Japanese. Internal Medicine, 2003, 42(7): 571-575.
10.	Ngeh J, Gupta S, Goodbourn C, et al. Chlamydia pneumoniae in elderly patients with stroke (C-PEPS): a case-control study on the seroprevalence of Chlamydia pneumoniae in elderly patients with acute cerebrovascular disease. Cerebrovascular Diseases, 2003, 15(1-2): 11-16.
11.	鄒蓉, 潘思爭, 賴頌輝, 等. 肺炎衣原體感染與腦卒中的相關性研究. 中國綜合臨床, 2003, 19(10): 881-882.
12.	Anzini A, Cassone A, Rasura M, et al. Chlamydia pneumoniae infection in young stroke patients: a case--control study. European Journal of Neurology, 2004, 11(5): 321-327.
13.	李愛東, 曾意蓮, 黃宗青, 等. 肺炎衣原體血清陽性率與缺血性腦卒中的關系. 中華現代內科雜志, 2004, 1(2): 146-148.
14.	Ngeh J, Gupta S, Goodbourn C, et al. Mycoplasma pneumoniae in elderly patients with stroke. a case-control study on the seroprevalence of M. pneumoniae in elderly patients with acute cerebrovascular disease - the M-PEPS Study. Cerebrovascular Diseases, 2004, 17(4): 314-319.
15.	李鳳玲, 時寶林, 劉瑞春. 腦血管病患者血清肺炎衣原體抗體的檢測及病因探討. 腦與神經疾病雜志, 2004, 12(5): 377-378.
16.	鄒蓉, 賴頌輝, 劉彥, 等. 腦梗塞患者血清肺炎衣原體特異性抗體的檢測. 中國預防醫學雜志, 2004, 5(2): 100-102.
17.	Johnsen SP, Overvad K, Ostergaard L, et al. Chlamydia pneumoniae seropositivity and risk of ischemic stroke: a nested case-control study. European Journal of Epidemiology, 2005, 20(1): 59-65.
18.	鄧英太, 曾蓮意, 黃宗青, 等. 缺血性腦卒中與肺炎衣原體感染的關系. 海南醫學院學報, 2005, 11(4): 269-271.
19.	Njamnshi AK, Blackett KN, Mbuagbaw JN,et al. Chronic chlamydia pneumoniae infection and stroke in Cameroon: a case-control study. Stroke, 2006, 37(3):796-799.
20.	Elkind MS, Tondella ML, Feikin DR, et al. Seropositivity to Chlamydia pneumoniae is associated with risk of first ischemic stroke. Stroke, 2006, 37(3): 790-795.
21.	劉愛民, 徐堅, 余竹元. 腦卒中患者血清中的肺炎衣原體抗體和超敏C-反應蛋白. 中國臨床康復, 2006, 70(38): 85-86.
22.	曾蓮意, 李愛東, 鄧英太, 等. 肺炎衣原體感染與急性腦梗死的相關性. 中國誤診學雜志, 2006, 6(7): 1215-1217.
23.	陳蕾, 周玉穎, 馬溫良, 等. 高敏C反應蛋白和肺炎衣原體感染與頸動脈粥樣硬化及缺血性腦卒中的相關性研究. 中華老年心腦血管病雜志, 2006, 8(5): 319-321.
24.	遲蘭芹, 王平, 張晨. 肺炎衣原體感染、炎性反應與腦梗死的臨床相關性研究. 中國醫師進修雜志, 2007, 30(9): 14-16.
25.	李濤, 吳正林, 許香廣, 等. 血清肺炎衣原體感染與急性冠脈綜合征的關系研究. 中華醫院感染學雜志, 2004, 14(5): 499-501.

1. Chiu B, Vim E, Tucker W, et a1. Chlamydia pneumoniae, cytomegalovirus, and herpes simplex vires in atherosclerosis of the carotid artery. Circulation, 1997, 96: 2144-2148.
2. Pellicano R. Is there an association between Helicobacter pylori infection and coronary heart disease? Eur Jor of Epi, 1999, 15(7): 611-619.
3. Wimmer ML, Sandmann-Strupp R, Saikku P, et al. Association of chlamydial infection with cerebrovascular disease. Stroke, 1996, 27(12): 2207-2210.
4. Cook PJ, Honeybourne D, Lip GY, et al. Chlamydia pneumoniae antibody titers are significantly associated with acute stroke and transient cerebral ischemia: the West Birmingham Stroke Project. Stroke, 1998, 29(2): 404-410.
5. Glader CA, Stegmayr B, Boman J, et al. Chlamydia pneumoniae antibodies and high lipoprotein(a) levels do not predict ischemic cerebral infarctions. Results from a nested case-control study in Northern Sweden. Stroke, 1999, 30(10): 2013-2018.
6. Elkind MS, Lin IF, Grayston JT, et al. Chlamydia pneumoniae and the risk of first ischemic stroke: The Northern Manhattan Stroke Study. Stroke, 2000, 31(7): 1521-1525.
7. Heuschmann PU, Neureiter D, Gesslein M, et al. Association between infection with Helicobacter pylori and Chlamydia pneumoniae and risk of ischemic stroke subtypes: Results from a population-based case-control study. Stroke, 2001, 32(10): 2253-2258.
8. Madre JG, Garcia JL, Gonzalez RC, et al. Escribano JR. Martinez JD. Cenjor RF. Association between seropositivity to Chlamydia pneumoniae and acute ischaemic stroke. European Journal of Neurology, 2002, 9(3): 303-306.
9. Kawamoto R, Kajiwara T, Oka Y, et al. An association between an antibody against Chlamydia pneumoniae and ischemic stroke in elderly Japanese. Internal Medicine, 2003, 42(7): 571-575.
10. Ngeh J, Gupta S, Goodbourn C, et al. Chlamydia pneumoniae in elderly patients with stroke (C-PEPS): a case-control study on the seroprevalence of Chlamydia pneumoniae in elderly patients with acute cerebrovascular disease. Cerebrovascular Diseases, 2003, 15(1-2): 11-16.
11. 鄒蓉, 潘思爭, 賴頌輝, 等. 肺炎衣原體感染與腦卒中的相關性研究. 中國綜合臨床, 2003, 19(10): 881-882.
12. Anzini A, Cassone A, Rasura M, et al. Chlamydia pneumoniae infection in young stroke patients: a case--control study. European Journal of Neurology, 2004, 11(5): 321-327.
13. 李愛東, 曾意蓮, 黃宗青, 等. 肺炎衣原體血清陽性率與缺血性腦卒中的關系. 中華現代內科雜志, 2004, 1(2): 146-148.
14. Ngeh J, Gupta S, Goodbourn C, et al. Mycoplasma pneumoniae in elderly patients with stroke. a case-control study on the seroprevalence of M. pneumoniae in elderly patients with acute cerebrovascular disease - the M-PEPS Study. Cerebrovascular Diseases, 2004, 17(4): 314-319.
15. 李鳳玲, 時寶林, 劉瑞春. 腦血管病患者血清肺炎衣原體抗體的檢測及病因探討. 腦與神經疾病雜志, 2004, 12(5): 377-378.
16. 鄒蓉, 賴頌輝, 劉彥, 等. 腦梗塞患者血清肺炎衣原體特異性抗體的檢測. 中國預防醫學雜志, 2004, 5(2): 100-102.
17. Johnsen SP, Overvad K, Ostergaard L, et al. Chlamydia pneumoniae seropositivity and risk of ischemic stroke: a nested case-control study. European Journal of Epidemiology, 2005, 20(1): 59-65.
18. 鄧英太, 曾蓮意, 黃宗青, 等. 缺血性腦卒中與肺炎衣原體感染的關系. 海南醫學院學報, 2005, 11(4): 269-271.
19. Njamnshi AK, Blackett KN, Mbuagbaw JN,et al. Chronic chlamydia pneumoniae infection and stroke in Cameroon: a case-control study. Stroke, 2006, 37(3):796-799.
20. Elkind MS, Tondella ML, Feikin DR, et al. Seropositivity to Chlamydia pneumoniae is associated with risk of first ischemic stroke. Stroke, 2006, 37(3): 790-795.
21. 劉愛民, 徐堅, 余竹元. 腦卒中患者血清中的肺炎衣原體抗體和超敏C-反應蛋白. 中國臨床康復, 2006, 70(38): 85-86.
22. 曾蓮意, 李愛東, 鄧英太, 等. 肺炎衣原體感染與急性腦梗死的相關性. 中國誤診學雜志, 2006, 6(7): 1215-1217.
23. 陳蕾, 周玉穎, 馬溫良, 等. 高敏C反應蛋白和肺炎衣原體感染與頸動脈粥樣硬化及缺血性腦卒中的相關性研究. 中華老年心腦血管病雜志, 2006, 8(5): 319-321.
24. 遲蘭芹, 王平, 張晨. 肺炎衣原體感染、炎性反應與腦梗死的臨床相關性研究. 中國醫師進修雜志, 2007, 30(9): 14-16.
25. 李濤, 吳正林, 許香廣, 等. 血清肺炎衣原體感染與急性冠脈綜合征的關系研究. 中華醫院感染學雜志, 2004, 14(5): 499-501.

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肺炎衣原體感染和腦梗死關系的Meta分析

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《中國循證醫學雜志》

肺炎衣原體感染和腦梗死關系的Meta分析

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