Helicobacter pylori infection and early onset myocardial infarction: case-control and sibling pairs study

OBJECTIVES: To examine the association between coronary heart disease and chronic Helicobacter pylori infection. DESIGN: Case-control study of myocardial infarction at young ages and study of sibling pairs with one member affected and the other not. SETTING: United Kingdom. PARTICIPANTS: 1122 survivors of suspected acute myocardial infarction at ages 30-49 (mean age 44 years) and 1122 age and sex matched controls with no history of coronary heart disease; 510 age and sex matched pairs of siblings (mean age 59 years) in which one sibling had survived myocardial infarction and one had no history of coronary heart disease. MAIN OUTCOME MEASURES: Serological evidence of chronic infection with H pylori. RESULTS: 472 (42%) of the 1122 cases with early onset myocardial infarction were seropositive for H pylori antibodies compared with 272 (24%) of the 1122 age and sex matched controls, giving an odds ratio of 2.28 (99% confidence interval 1.80 to 2.90). This odds ratio fell to 1.87 (1.42 to 2.47; P<0.0001) after smoking and indicators of socioeconomic status were adjusted for and to 1.75 (1.29 to 2.36) after additional adjustment for blood lipid concentrations and obesity. Only 158 of the 510 pairs of siblings were discordant for H pylori status; among these, 91 cases and 67 controls were seropositive (odds ratio 1.33 (0.86 to 2.05)). No strong correlations were observed between H pylori seropositivity and measurements of other risk factors for coronary heart disease (plasma lipids, fibrinogen, C reactive protein, albumin, etc). CONCLUSION: In the context of results from other relevant studies, these two studies suggest a moderate association between coronary heart disease and H pylori seropositivity that cannot be fully accounted for by other risk factors. But even if this association is causal and largely reversible by eradication of chronic infection, very large randomised trials would be needed to show this.

研究目标：探讨冠心病（coronary heart disease）与慢性幽门螺杆菌（Helicobacter pylori）感染之间的关联。研究设计：本研究包含两项队列，其一为针对早发性心肌梗死的病例对照研究，其二为纳入1例患病、1例未患病个体的同胞对研究。研究地点：英国。研究对象：1122名年龄30~49岁（平均年龄44岁）的疑似急性心肌梗死存活患者，以及1122名年龄、性别匹配且无冠心病病史的对照个体；另纳入510对年龄、性别匹配的同胞对（平均年龄59岁），每对同胞中1名曾罹患心肌梗死并存活，另1名无冠心病病史。主要结局指标：慢性幽门螺杆菌感染的血清学证据。结果：1122名早发性心肌梗死患者中，472例（42%）幽门螺杆菌抗体血清学检测呈阳性，而1122名年龄、性别匹配的对照个体中仅272例（24%）呈阳性，比值比为2.28（99%置信区间1.80~2.90）。校正吸烟状况与社会经济地位指标后，该比值比降至1.87（99%置信区间1.42~2.47；P<0.0001）；进一步校正血脂浓度与肥胖指标后，比值比进一步降至1.75（1.29~2.36）。在510对同胞对中，仅158对的幽门螺杆菌感染状态不一致；其中91例患病同胞与67例未患病同胞呈血清学阳性，比值比为1.33（0.86~2.05）。未观察到幽门螺杆菌血清学阳性与冠心病其他危险因素（血浆脂质、纤维蛋白原、C反应蛋白、白蛋白等）存在显著相关性。结论：结合其他相关研究结果，本两项研究提示冠心病与幽门螺杆菌血清学阳性之间存在中等强度关联，且该关联无法完全通过其他危险因素解释。即便该关联具有因果性且可通过根除慢性感染得到显著逆转，仍需开展大规模随机对照试验以验证这一结论。