suggest that high titer of IgG antibody against H. pylori may be associated with CAD, and inflammation may play a significant role in the pathogenesis

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1 Original Articles Korean Circulation J 2000;309: 한국인에서관상동맥질환에대한만성감염및염증의역할 김계훈 1 정명호 2 신종희 2 주신배 1 김원 1 이승욱 1 김건형 1 김남호 1 조장현 1 박종철 1 안영근 1 나국주 1 조정관 2 안병희 2 박종춘 2 강정채 1 The Role of Chronic Infection and Inflammation in Korean Patients with Coronary Artery Disease Kye Hun Kim, MD 1, Myung Ho Jeong, MD 2, Jong Hee Shin, MD 2, Shin Bae Joo, MD 1, Weon Kim, MD 1, Seung Uk Lee, MD 1, Kun Hyung Kim, MD 1, Nam Ho Kim, MD 1, Jang Hyun Cho, MD 1, Jong Choel Park, MD 1, Kook Joo Na, MD 1, Young Keun Ahn, MD 1, Jeong Gwan Cho, MD 1, Byoung Hee Ahn, MD 2, Jong Chun Park, MD 2 and Jung Chaee Kang, MD 2 1 Department of Internal Medicine, The Heart Center, Chonnam National University Hospital, Seoul, 2 The Research Institute of Medical Sciences, Kwangju, Korea ABSTRACT BackgroundChronic infections, including Chlamydia pneumoniae, cytomegalovirus and Helicobacter pylori may be one of the risk factors for coronary artery disease CAD. To document whether chronic infection may be associated with coronary artery disease, various inflammatory markers were analyzed in Korean patients with CAD. MethodsThe patients who underwent diagnostic coronary angiography CAG were divided into two groups according to the results of CAGthe patients with significant coronary lesions Group n126, MF9927, years or the patients without coronary lesions Group n58, MF3028, years. Serologic assays for the immunoglobulin G IgG titers to C. pneumoniae, CMV, H. pylori, and for inflammatory markers, including erythrocyte sedimentation rate ESR and C-reactive protein CRP were performed. ResultsThere were no significant differences in the seropositivity of three infections between two groups, but titer of IgG antibody against H. pylori was significantly higher in Group than that in Group vs U/mL, p0.02. After adjustment for age, sex and other cardiovascular risk factors, high titer of IgG antibody aganist H. pylori was independently associated with coronary artery disease p0.05. CRP and ESR were significantly elevated in group vs mg/dl, p0.003, vs mm/hr, p Angiographic parameters were not related with the titer of infectious agents or inflammatory markers. The value of CRP was significantly different according to clinical severity in acute myocardial infarction, in unstable angina pectoris, and mg/dl in stable angina pectoris, p0.01. The value of ESR was also significantly different according to clinical severity in acute myocardial infarction, in unstable angina pectoris, and mm/hr in stable angina pectoris, p0.01. ConclusionsOur results 1107

2 suggest that high titer of IgG antibody against H. pylori may be associated with CAD, and inflammation may play a significant role in the pathogenesis of acute coronary syndromes. Korean Circulation J 2000;309: KEY WORDSInfection Inflammation Coronary artery disease. 서론 대상환자 대상및방법 방법 1108 Korean Circulation J 2000;309:

3 관상동맥조영술소견분석 통계방법 결과 임상적특징 감염과관상동맥질환 Table 1. Comparisons of clinical characteristics between Group with coronary artery disease and Group without coronary artery disease Group Group P value Number Age yrs Sex % 0.01 Male Female Clinical diagnosis % Acute myocardial infarction Unstable angina Stable angina Silent ischemia Risk factors % Smoking Hypertension NS Diabetes mellitus NS Hypercholesterolemia NS 1109

4 Table 2. Comparisons of seropositivity of infectious and inflammatory markers between Group with coronary artery disease and Group without coronary artery disease Group n126 Group n58 P value C. pneumoniae % NS CMV % NS H. pylori % NS CRP% ESR % C. pneumoniaechlamydia pneumoniae, CMVCytomegalovirus, H. pylorihelicobacter pylori, CRPCreactive protein, ESRerythrocyte sedimentation rate. 염증지표와관상동맥질환 Fig. 1. Titer of IgG antibody against Helicobacter pylori was significantly higher in patients with coronary artery disease CAD than in normal control group. Table 3. Comparisons of seropositivity of infectious agents according to clinical diagnosis AMI n68 UAP n40 SAP P n17 value C. pneumoniae % NS CMV % NS H. pylori % NS AMIacute myocardial infarction, UAPunstable angina pectoris, SAPstable angina pectoris, C. pneumoniaechlamydia pneumoniae, CMVCytomegalovirus, H. pylorihelicobacter pylori Fig. 2. The distribution of antibody titer aganist H. pylori between group with coronary artery disease and group without coronary artery disease Korean Circulation J 2000;309:

5 Table 4. Comparisons of serum concentrations of inflammatory markers between Group with coronary artery disease and Group without coronary artery disease Group n126 Group n58 P value CRP mg/dl ESRmm/hr Fibrinogenmg/dL CRPC-reactive protein ESRerythrocyte sedimentation rate. Table 5. Angiographic characteristics of the patient group Target lesion Number % Left anterior descending artery Right coronary artery Left circumflex artery Number of involved vessel One vessel disease Two vessel disease Three vessel disease 11 9 TIMI flow grade AHA/ACC types A 4 2 B B C TIMI Thrombolysis in myocardial infarction, AHA/ ACCAmerican Heart Association/American College of Cardiology 감염과염증지표 관상동맥조영술소견과비교 Fig. 3. The levels of C- reactive protein CRP and erythrocyte sedimentation rate ESR are significantly elevated in coronary artery disease CAD group than in normal control group. 1111

6 Fig. 4. There are significant differences in the level of C- reactive protein CRP according to clinical diagnosis mg/dl in stable angina pectoris SAP, mg/dl in unstable angina pectoris UAP, mg/dl in acute myocardial infarction AMI. Fig. 5. There are significant differences in the level of erythrocyte sedimentation rate ESRaccording to clinical diagnosis mm/hr in stable angina pectoris SAP, mm/hr in unstable angina pectoris UAP, mm/hr in acute myocardial infarction AMI 고안 Korean Circulation J 2000;309:

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