2025 年第 7 期 第 20 卷

老年冠心病患者幽门螺杆菌感染情况及其血清抗体分型与冠状动脉病变程度的相关性

The prevalence of Helicobacter pylori infection in elderly patients with coronary atherosclerotic heart disease and the correlation between their serum antibody types and the degree of coronary artery disease

作者：张晨徐颖芝李莹

英文作者：Zhang Chen Xu Yingzhi Li Ying

单位：西部战区总医院干部一科三病区，成都610000

英文单位：Ward 3 First Department of Cadre Western Theater General Hospital Chengdu 610000 China

关键词：冠心病（冠状动脉粥样硬化性心脏病）；幽门螺杆菌；血清抗体分型；冠状动脉病变

英文关键词：Coronaryatheroscleroticheartdisease;Helicobacterpylori;Serumantibodytyping;Coronaryarterydisease

• 摘要：

• 目的 探讨老年冠心病（冠状动脉粥样硬化性心脏病）患者幽门螺杆菌（Hp）感染情况及Hp血清抗体分型与冠状动脉病变的关系。方法 选取2021年4月至2023年6月于西部战区总医院就诊的217例冠心病患者为研究对象，通过Gensini评分三分位数法将患者分为轻度组（72例）、中度组（74例）和重度组（71例）。收集各组患者一般资料，检测各组患者血清生化指标、炎症因子指标［高敏C反应蛋白（hs-CRP）、白细胞介素6（IL-6）、肿瘤坏死因子α（TNF-α）］及Hp血清抗体分型，并评估患者斑块情况。分析影响老年冠心病患者冠状动脉病变严重程度的相关因素；分析Hp亚型与炎症因子水平的相关性。结果 3组Hp感染、高危斑块、冠状动脉多支病变比例比较差异均有统计学意义（均P<0.05）。多支病变、高危斑块的患者中细胞毒素相关基因A产物（CagA）/毒性空泡细胞毒素（VacA）检出率分别高于单支病变、非高危斑块患者［40.7%(35/86)比19.8%（26/131）、48.5%（32/66）比19.2%（29/151）］，且CagA/VacA检出率在轻度组、中度组、重度组中呈上升趋势［8.3%（6/72）、28.4%（21/74）、47.9%（34/71）］（均P＜0.05）。中度组和重度组总胆固醇、甘油三酯、低密度脂蛋白胆固醇（LDL-C）、hs-CRP、IL-6、TNF-α水平均高于轻度组，且重度组均高于中度组（均P<0.05）。有序Logistic回归分析结果显示，CagA/VacA亚型、总胆固醇、甘油三酯、LDL-C、hs-CRP、IL-6、TNF-α水平均为影响老年冠心病患者冠状动脉病变程度的独立危险因素（均P<0.05）。在轻度组、中度组、重度组中，CagA/VacA亚型感染患者hs-CRP、IL-6、TNF-α水平均高于UreA/UreB亚型感染患者（均P<0.05）。hs-CRP、IL-6、TNF-α水平均与CagA/VacA亚型呈正相关（均P<0.05），且均与UreA/UreB亚型呈负相关（均P<0.05）。结论 Hp感染与老年冠心病患者冠状动脉病变程度密切相关，Hp阳性且血清抗体分型为CagA/VacA的老年冠心病患者冠状动脉病变程度更严重。

• Objective   To investigate the prevalence of Helicobacter pylori (Hp)infection in elderly patients with coronary atherosclerotic heart disease (CHD) and the correlation between their serum antibody types and the degree of coronary artery disease. Methods A total of 217 patients with CHD who were admitted to Western Theater General Hospital from April 2021 to June 2023 were selected as the research objects. The patients were divided into mild group (72 cases), moderate group (74 cases) and severe group (71 cases) according to the Gensini score tertiles. The general data of patients in each group were collected, the serum biochemical indexes, inflammatory factor indexes ［high-sensitivity C-reactive protein (hs-CRP), interleukin-6 (IL-6), tumor necrosis factor-α (TNF-α)］ and Hp serum antibody classification of patients in each group were detected, and the plaque status of patients was evaluated. The related factors affecting the severity of coronary artery disease in elderly patients with CHD were analyzed. The correlation between Hp subtypes and levels of inflammatory factors was analyzed. Results There were significant differences in the proportion of Hp infection, high-risk plaque, and multi-vessel coronary artery disease among the three groups (all P<0.05). The detection rates of cytotoxin-associated gene A product (CagA)/toxic vacuolated cytotoxin (VacA) in patients with multi-vessel lesions and high-risk plaque were higher than those in patients with single-vessel lesions and non-high-risk plaque［40.7%(35/86) vs 19.8%(26/131)， 48.5%(32/66) vs 19.2%(29/151)］, and the detection rate of CagA/VacA increased in the mild group, moderate group and severe group ［8.3%(6/72), 28.4%(21/74) and 47.9%(34/71)］(all P<0.05). The levels of total cholesterol, triglyceride, low-density lipoprotein cholesterol (LDL-C), hs-CRP, IL-6 and TNF-α in the moderate and severe groups were higher than those in the mild group, and those in the severe group were higher than those in the moderate group (all P<0.05). Ordinal Logistic regression analysis showed that the levels of CagA/VacA subtype, total cholesterol, triglyceride, LDL-C, hs-CRP, IL-6 and TNF-α were all the independent risk factors for the severity of coronary artery disease in elderly patients with CHD (all P<0.05). The levels of hs-CRP, IL-6 and TNF-α in patients with CagA/VacA infection were higher than those with UreA/UreB infection in the mild, moderate and severe groups (all P<0.05). The levels of hs-CRP, IL-6 and TNF-α were positively correlated with the CagA/VacA subtype (all P<0.05), and negatively correlated with the UreA/UreB subtype (all P<0.05). Conclusions Hp infection is closely related to the degree of coronary artery lesions in elderly CHD patients. The degree of coronary artery lesions is more serious in elderly CHD patients with Hp positive and CagA/VacA antibody type.