Martin O. Sundqvist, Jonatan Wärme, Marcus Hjort, Per Tornvall, Tomas Jernberg, Bertil Lindahl, Alexandru Schiopu, Tomasz Baron, Stefan H. Jacobson, Thomas Kahan, David Erlinge, Jonas Spaak, Robin Hofmann
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Furthermore, it aims to investigate the association of Hp infection and biomarkers with major adverse cardiovascular events (MACE) and mortality.</p>\n </section>\n \n <section>\n \n <h3> Materials and Methods</h3>\n \n <p>Hp, CagA serology, and 175 cardiovascular biomarkers were analyzed in 1061 patients with MI admitted between 2008 and 2014. Associations between Hp and seven pre-selected biomarkers were evaluated. Exploratory analyses included all biomarkers using machine-learning models to predict Hp-status. Hp-status and the top predictors were analyzed for associations with outcomes using Cox regression.</p>\n </section>\n \n <section>\n \n <h3> Results</h3>\n \n <p>Median age was 65 years; 78% were male. Hp and CagA seroprevalence were 45% and 19%, respectively. Patients with Hp had elevated CRP (<i>β</i> = 0.26, 95% CI 0.01–0.51). Predictive performance of Hp-status was moderate (AUC 0.63–0.68). Exploratory analysis identified higher levels of C-C motif chemokine ligand 20 (CCL20) and immunoglobulin heavy constant gamma-3 (IGHG3), and lower levels of TNF-related apoptosis-inducing ligand (TRAIL) in patients with Hp-positivity. Elevated CCL20 and reduced TRAIL, but not Hp, were associated with MACE and all-cause mortality.</p>\n </section>\n \n <section>\n \n <h3> Conclusions</h3>\n \n <p>Hp may contribute to an inflammatory response in patients with MI, indicated by higher CRP and inflammatory/immune-modulatory biomarkers emerging as its top predictors. 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引用次数: 0
摘要
背景：幽门螺杆菌（Hp）及其毒力因子细胞毒素相关基因A （CagA）与心肌梗死（MI）有关，但其机制尚不清楚。本研究旨在测试Hp感染和CagA是否与心肌梗死患者预先指定的炎症和血管生物标志物相关，并探索更广泛的生物标志物是否可以预测感染。此外，该研究旨在调查Hp感染和生物标志物与主要不良心血管事件（MACE）和死亡率的关系。材料和方法：对2008年至2014年收治的1061例心肌梗死患者的Hp、CagA血清学和175项心血管生物标志物进行分析。评估了Hp与7种预先选择的生物标志物之间的关联。探索性分析包括使用机器学习模型预测hp状态的所有生物标志物。使用Cox回归分析hp状态和最高预测因子与结果的相关性。结果：中位年龄65岁；78%是男性。Hp和CagA血清阳性率分别为45%和19%。Hp患者CRP升高（β = 0.26, 95% CI 0.01-0.51）。hp状态的预测性能一般（AUC为0.63-0.68）。探索性分析发现，在hp阳性患者中，C-C基序趋化因子配体20 （CCL20）和免疫球蛋白重常量γ -3 （IGHG3）水平较高，tnf相关凋亡诱导配体（TRAIL）水平较低。CCL20升高和TRAIL降低与MACE和全因死亡率相关，但与Hp无关。结论：Hp可能促进心肌梗死患者的炎症反应，CRP升高和炎症/免疫调节生物标志物成为其主要预测因素。虽然Hp与心肌梗死后的不良结果无关，但其预测炎症生物标志物与MACE和死亡率相关。试验注册：该研究未注册为临床试验，因为它是一项观察性研究。
Helicobacter pylori, Inflammation, and Long-Term Outcome in Patients With Acute Myocardial Infarction: A Prospective Cohort Study
Background
Helicobacter pylori (Hp) and its virulence factor Cytotoxin-associated gene A (CagA) have been linked to myocardial infarction (MI), but the mechanisms are unknown. This study aims to test if Hp infection and CagA are associated with pre-specified inflammatory and vascular biomarkers in patients with MI and to explore whether a broader biomarker panel can predict infection. Furthermore, it aims to investigate the association of Hp infection and biomarkers with major adverse cardiovascular events (MACE) and mortality.
Materials and Methods
Hp, CagA serology, and 175 cardiovascular biomarkers were analyzed in 1061 patients with MI admitted between 2008 and 2014. Associations between Hp and seven pre-selected biomarkers were evaluated. Exploratory analyses included all biomarkers using machine-learning models to predict Hp-status. Hp-status and the top predictors were analyzed for associations with outcomes using Cox regression.
Results
Median age was 65 years; 78% were male. Hp and CagA seroprevalence were 45% and 19%, respectively. Patients with Hp had elevated CRP (β = 0.26, 95% CI 0.01–0.51). Predictive performance of Hp-status was moderate (AUC 0.63–0.68). Exploratory analysis identified higher levels of C-C motif chemokine ligand 20 (CCL20) and immunoglobulin heavy constant gamma-3 (IGHG3), and lower levels of TNF-related apoptosis-inducing ligand (TRAIL) in patients with Hp-positivity. Elevated CCL20 and reduced TRAIL, but not Hp, were associated with MACE and all-cause mortality.
Conclusions
Hp may contribute to an inflammatory response in patients with MI, indicated by higher CRP and inflammatory/immune-modulatory biomarkers emerging as its top predictors. Although Hp was not associated with adverse outcomes after MI, its predictive inflammatory biomarkers were associated with MACE and mortality.
Trial Registration
The study was not registered as a clinical trial, as it was an observational study
期刊介绍：
Helicobacter is edited by Professor David Y Graham. The editorial and peer review process is an independent process. Whenever there is a conflict of interest, the editor and editorial board will declare their interests and affiliations. Helicobacter recognises the critical role that has been established for Helicobacter pylori in peptic ulcer, gastric adenocarcinoma, and primary gastric lymphoma. As new helicobacter species are now regularly being discovered, Helicobacter covers the entire range of helicobacter research, increasing communication among the fields of gastroenterology; microbiology; vaccine development; laboratory animal science.
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