幽門螺旋桿菌可能提升心室纖維顫動的風險


  June 17, 2005 - 根據心臟醫學(Heart)期刊七月號刊載,幽門螺旋桿菌可能會提升心室纖維顫動(AF)的風險。
  
  來自義大利米蘭Sesto San Giovanni,Policlinico Multimedica醫院的A.S. Montenero醫師指出,感染幽門螺旋桿菌會引發慢性胃炎,這項非心肌性的疾病很容易導致心室纖維顫動症狀,因此對於慢性心室發炎導致的心室纖維顫動,我們假設,幽門螺旋桿菌可能會原因之一。
  
  在2002年3月與2003年1月間,研究人員招募了59位連續性的患者參與試驗,或為陣發性,或為持續性的心室纖維顫動患者,本試驗為一心臟電擊術及電位生理的研究;患者中有一部分並無構造性的心臟病,一部分正在接受高血壓的治療;作為比較的對照組,包含45位健康志願者,並無心室心律不整或伴隨的急慢性疾病;排除於試驗之外的症狀,含心肌梗塞者、曾經進行過胸腔心臟手術者、缺血性心臟病者、心瓣膜病變者、甲狀腺病變者、先天性心臟病者、糖尿病者及急慢性感染者。
  
  兩組的平均年齡皆類似,其他如最常見的風險因子,膽固醇、低密度脂蛋白膽固醇及三酸甘油脂等,兩組皆相同;心室纖維顫動試驗組中,接受高血壓治療者較之對照組為高;持續性心室纖維顫動的患者(n=29),年齡較陣發性心室纖維顫動(n=30)者為高,接受高血壓治療的情形也較普遍。
  
  相較於對照組,心室纖維顫動組的幽門螺旋桿菌陽性血清濃度較高(97.2[50.5-100.0]IU/mL vs 5.3[5.0-33.9]IU/mL),C反應蛋白(CRP)也比較高(8[6-10] mg/L) vs 1[0-2] mg/L)。
  
  在調整過年齡的差異後,持續性心室纖維顫動患者的陽性血清及C反應蛋白皆高於陣發性者(100(72.6-100.0)IU/mL vs 60.2(35.9-100.0)IU/mL;9(7-11)mg/mL vs 7(6-10)mg/mL)。
  
  持續性心室纖維顫動患者的心室纖維顫動與幽門螺旋桿菌之間的關係非常強烈;Montenero表示,我們另外也提報了高濃度的C反應蛋白,這對心室纖維顫動患者的全身發炎現象作了證實;這個現象使得我們作出一項假設,亦即,心室纖維顫動患者之所以會全身發炎,是因為幽門螺旋桿菌的關係;至於幽門螺旋桿菌如何對心室纖維顫動發病原因作影響,我們需要更多的資料才能證實。

Helicobacter pylori May Be Ass

By Laurie Barclay, MD
Medscape Medical News

June 17, 2005 — Helicobacter pylori is associated with an increased risk of atrial fibrillation (AF), according to the results of a case-control study published in the July issue of Heart.

"A potential non-cardiovascular disease that predisposes to AF may be chronic gastritis caused by chronic Helicobacter pylori infection," write A.S. Montenero, MD, from Policlinico Multimedica, Sesto San Giovanni in Milan, Italy, and colleagues. "Thus, we hypothesised that H. pylori may be involved in the chronic atrial inflammation resulting in AF."

Between March 2002 and January 2003, the investigators enrolled 59 consecutive patients with a paroxysmal or persistent form of AF who were admitted for cardioversion and electrophysiological study, including some patients without structural heart disease and some who were prescribed medication for hypertension. They compared these patients with a control group of 45 healthy volunteers with no history of atrial arrhythmias or concomitant acute or chronic disease. Patients with myocardial infarction, prior cardiothoracic surgery, ischemic heart disease, valvular disease, thyroid dysfunction, congenital heart disease, diabetes, and acute or chronic infections were excluded.

Both groups were similar in terms of mean age, most traditional risk factors and cholesterol, low-density lipoprotein cholesterol, and triglyceride levels. More patients were being treated for hypertension in the AF group than in the control group. Patients with persistent AF (n = 29) were older than patients with paroxysmal AF (n = 30), and they had a higher prevalence of treated hypertension.

Compared with the control group, the AF group had significantly higher H. pylori seropositivity (97.2 [50.5 - 100.0] IU/mL vs 5.3 [5.0 - 33.9] IU/mL) and C-reactive protein (CRP) (8 [6 - 10] mg/L) vs 1 [0 - 2] mg/L; P < .001) for both comparisons.

After adjustment for differences in age, H. pylori seropositivity and CRP were both significantly higher in patients with persistent AF than in those with paroxysmal AF (100 (72.6 - 100.0) IU/mL vs 60.2 (35.9 - 100.0) IU/mL; P = .027, and 9 (7 - 11) mg/L vs 7 (6 - 10) mg/L; P = .041, respectively).

"The association between AF and H. pylori was very strong in patients with persistent AF," the authors write. "In addition, we report high concentrations of CRP, which confirm the presence of systemic inflammation in patients with AF, which leads us to hypothesise that H pylori infection may be the substrate of this systemic inflammation manifesting in AF.??More data will be necessary from controlled studies to further identify how H. pylori can influence the pathogenesis of AF."

Heart. 2005;91:960-961

Reviewed by Gary D. Vogin, MD

    
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