Association between Chlamydia Pneumoniae Infection and Cerebral Infarction: A Meta-analysis_Chinese Journal of Evidence-Based Medicine

Authors：

YU Liang ^1,2 , BAI Shuanglian ³ ,  TONG Weijun ¹

1. School of Radiation Medicine and Public Health, Department of Medicine of School University, Suzhou 215123, China;2. Wuxi Hospital for Maternal and Child Health Care, Wuxi 214001, China;3. Kezuohouqi Center for Disease Control and Prevention, Tongliao 028000, Inner Mongolia, China;

Corresponding author：

TONG Weijun, Email: t_weijun@yahoo.com.cn

Keywords：

Cerebral infarction; Chlamydia pneumoniae; Meta-analysis; Infection

DOI：

10.7507/1672-2531.20090151

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Objective 　To review the association between chlamydia pneumoniae (CP) infection and cerebral infarction.
Methods 　We electronically searched MEDLINE, BIOSIS, VIP database, and China Full Text Journal Database from Jan. 1990 through Dec. 2007 to identify case-control studies about the association of CP and cerebral infarction. The quality of the included studies was assessed and the RevMan 4.2 software was used for meta-analyses.
Results 　A total of 22 studies were included. The results of meta-analyses showed: ① When the microimmunofluorescence (MIF) method was used to examine CP antibody in serum, the positive rate of the cerebral infarction group was higher than that of the control group when the positive infection was defined by IgA≥1?16 [n=8, OR=2.18, 95%CI (1.49 to 3.49), P lt;0.0001]; but when positive infection was defined by IgA≥1?32 (n=3), IgG≥1?32 (n=6), or IgG≥1?64 (n=5), there were no significant differences in the positive rate between the two groups [OR (95%CI) were 1.47 (0.97 to 2.24), 1.24 (0.82 to 1.86), and 1.23 (0.98 to 1.55), respectively]; ② When the ELISA method was used to examine CP-IgG antibody in serum, the positive rate of the cerebral infarction group was higher than that of the controlled group [n=8, OR=2.40, 95%CI (1.42 to 4.06), P=0.000 2]. ③ The acute and chronic CP infections were associated with the incidence of cerebral infarction [n=4, OR=7.22, 95%CI (2.68 to 19.49); n=4, OR=4.30, 95%CI (3.40 to 7.40)].
Conclusion 　① The association between CP infection and cerebral infarction is determined by the positive criterion. IgA antibody is more sensitive than the IgG antibody. When the positive infection is determined by IgA≥1?16, CP infection is associated with cerebral infarction. ② The results of ELISA for examining CP-IgG support the association between CP infection and cerebral infarction. ③ Both acute and chronic CP infections are associated with cerebral infarction, but these associations needed to be proven by more scientific studies.

Citation： YU Liang,BAI Shuanglian,TONG Weijun. Association between Chlamydia Pneumoniae Infection and Cerebral Infarction: A Meta-analysis. Chinese Journal of Evidence-Based Medicine, 2009, 09(8): 855-861. doi: 10.7507/1672-2531.20090151 Copy

1.	Chiu B, Vim E, Tucker W, et a1. Chlamydia pneumoniae, cytomegalovirus, and herpes simplex vires in atherosclerosis of the carotid artery. Circulation, 1997, 96: 2144-2148.
2.	Pellicano R. Is there an association between Helicobacter pylori infection and coronary heart disease? Eur Jor of Epi, 1999, 15(7): 611-619.
3.	Wimmer ML, Sandmann-Strupp R, Saikku P, et al. Association of chlamydial infection with cerebrovascular disease. Stroke, 1996, 27(12): 2207-2210.
4.	Cook PJ, Honeybourne D, Lip GY, et al. Chlamydia pneumoniae antibody titers are significantly associated with acute stroke and transient cerebral ischemia: the West Birmingham Stroke Project. Stroke, 1998, 29(2): 404-410.
5.	Glader CA, Stegmayr B, Boman J, et al. Chlamydia pneumoniae antibodies and high lipoprotein(a) levels do not predict ischemic cerebral infarctions. Results from a nested case-control study in Northern Sweden. Stroke, 1999, 30(10): 2013-2018.
6.	Elkind MS, Lin IF, Grayston JT, et al. Chlamydia pneumoniae and the risk of first ischemic stroke: The Northern Manhattan Stroke Study. Stroke, 2000, 31(7): 1521-1525.
7.	Heuschmann PU, Neureiter D, Gesslein M, et al. Association between infection with Helicobacter pylori and Chlamydia pneumoniae and risk of ischemic stroke subtypes: Results from a population-based case-control study. Stroke, 2001, 32(10): 2253-2258.
8.	Madre JG, Garcia JL, Gonzalez RC, et al. Escribano JR. Martinez JD. Cenjor RF. Association between seropositivity to Chlamydia pneumoniae and acute ischaemic stroke. European Journal of Neurology, 2002, 9(3): 303-306.
9.	Kawamoto R, Kajiwara T, Oka Y, et al. An association between an antibody against Chlamydia pneumoniae and ischemic stroke in elderly Japanese. Internal Medicine, 2003, 42(7): 571-575.
10.	Ngeh J, Gupta S, Goodbourn C, et al. Chlamydia pneumoniae in elderly patients with stroke (C-PEPS): a case-control study on the seroprevalence of Chlamydia pneumoniae in elderly patients with acute cerebrovascular disease. Cerebrovascular Diseases, 2003, 15(1-2): 11-16.
11.	邹蓉, 潘思争, 赖颂辉, 等. 肺炎衣原体感染与脑卒中的相关性研究. 中国综合临床, 2003, 19(10): 881-882.
12.	Anzini A, Cassone A, Rasura M, et al. Chlamydia pneumoniae infection in young stroke patients: a case--control study. European Journal of Neurology, 2004, 11(5): 321-327.
13.	李爱东, 曾意莲, 黄宗青, 等. 肺炎衣原体血清阳性率与缺血性脑卒中的关系. 中华现代内科杂志, 2004, 1(2): 146-148.
14.	Ngeh J, Gupta S, Goodbourn C, et al. Mycoplasma pneumoniae in elderly patients with stroke. a case-control study on the seroprevalence of M. pneumoniae in elderly patients with acute cerebrovascular disease - the M-PEPS Study. Cerebrovascular Diseases, 2004, 17(4): 314-319.
15.	李凤玲, 时宝林, 刘瑞春. 脑血管病患者血清肺炎衣原体抗体的检测及病因探讨. 脑与神经疾病杂志, 2004, 12(5): 377-378.
16.	邹蓉, 赖颂辉, 刘彦, 等. 脑梗塞患者血清肺炎衣原体特异性抗体的检测. 中国预防医学杂志, 2004, 5(2): 100-102.
17.	Johnsen SP, Overvad K, Ostergaard L, et al. Chlamydia pneumoniae seropositivity and risk of ischemic stroke: a nested case-control study. European Journal of Epidemiology, 2005, 20(1): 59-65.
18.	邓英太, 曾莲意, 黄宗青, 等. 缺血性脑卒中与肺炎衣原体感染的关系. 海南医学院学报, 2005, 11(4): 269-271.
19.	Njamnshi AK, Blackett KN, Mbuagbaw JN,et al. Chronic chlamydia pneumoniae infection and stroke in Cameroon: a case-control study. Stroke, 2006, 37(3):796-799.
20.	Elkind MS, Tondella ML, Feikin DR, et al. Seropositivity to Chlamydia pneumoniae is associated with risk of first ischemic stroke. Stroke, 2006, 37(3): 790-795.
21.	刘爱民, 徐坚, 余竹元. 脑卒中患者血清中的肺炎衣原体抗体和超敏C-反应蛋白. 中国临床康复, 2006, 70(38): 85-86.
22.	曾莲意, 李爱东, 邓英太, 等. 肺炎衣原体感染与急性脑梗死的相关性. 中国误诊学杂志, 2006, 6(7): 1215-1217.
23.	陈蕾, 周玉颖, 马温良, 等. 高敏C反应蛋白和肺炎衣原体感染与颈动脉粥样硬化及缺血性脑卒中的相关性研究. 中华老年心脑血管病杂志, 2006, 8(5): 319-321.
24.	迟兰芹, 王平, 张晨. 肺炎衣原体感染、炎性反应与脑梗死的临床相关性研究. 中国医师进修杂志, 2007, 30(9): 14-16.
25.	李涛, 吴正林, 许香广, 等. 血清肺炎衣原体感染与急性冠脉综合征的关系研究. 中华医院感染学杂志, 2004, 14(5): 499-501.

1. Chiu B, Vim E, Tucker W, et a1. Chlamydia pneumoniae, cytomegalovirus, and herpes simplex vires in atherosclerosis of the carotid artery. Circulation, 1997, 96: 2144-2148.
2. Pellicano R. Is there an association between Helicobacter pylori infection and coronary heart disease? Eur Jor of Epi, 1999, 15(7): 611-619.
3. Wimmer ML, Sandmann-Strupp R, Saikku P, et al. Association of chlamydial infection with cerebrovascular disease. Stroke, 1996, 27(12): 2207-2210.
4. Cook PJ, Honeybourne D, Lip GY, et al. Chlamydia pneumoniae antibody titers are significantly associated with acute stroke and transient cerebral ischemia: the West Birmingham Stroke Project. Stroke, 1998, 29(2): 404-410.
5. Glader CA, Stegmayr B, Boman J, et al. Chlamydia pneumoniae antibodies and high lipoprotein(a) levels do not predict ischemic cerebral infarctions. Results from a nested case-control study in Northern Sweden. Stroke, 1999, 30(10): 2013-2018.
6. Elkind MS, Lin IF, Grayston JT, et al. Chlamydia pneumoniae and the risk of first ischemic stroke: The Northern Manhattan Stroke Study. Stroke, 2000, 31(7): 1521-1525.
7. Heuschmann PU, Neureiter D, Gesslein M, et al. Association between infection with Helicobacter pylori and Chlamydia pneumoniae and risk of ischemic stroke subtypes: Results from a population-based case-control study. Stroke, 2001, 32(10): 2253-2258.
8. Madre JG, Garcia JL, Gonzalez RC, et al. Escribano JR. Martinez JD. Cenjor RF. Association between seropositivity to Chlamydia pneumoniae and acute ischaemic stroke. European Journal of Neurology, 2002, 9(3): 303-306.
9. Kawamoto R, Kajiwara T, Oka Y, et al. An association between an antibody against Chlamydia pneumoniae and ischemic stroke in elderly Japanese. Internal Medicine, 2003, 42(7): 571-575.
10. Ngeh J, Gupta S, Goodbourn C, et al. Chlamydia pneumoniae in elderly patients with stroke (C-PEPS): a case-control study on the seroprevalence of Chlamydia pneumoniae in elderly patients with acute cerebrovascular disease. Cerebrovascular Diseases, 2003, 15(1-2): 11-16.
11. 邹蓉, 潘思争, 赖颂辉, 等. 肺炎衣原体感染与脑卒中的相关性研究. 中国综合临床, 2003, 19(10): 881-882.
12. Anzini A, Cassone A, Rasura M, et al. Chlamydia pneumoniae infection in young stroke patients: a case--control study. European Journal of Neurology, 2004, 11(5): 321-327.
13. 李爱东, 曾意莲, 黄宗青, 等. 肺炎衣原体血清阳性率与缺血性脑卒中的关系. 中华现代内科杂志, 2004, 1(2): 146-148.
14. Ngeh J, Gupta S, Goodbourn C, et al. Mycoplasma pneumoniae in elderly patients with stroke. a case-control study on the seroprevalence of M. pneumoniae in elderly patients with acute cerebrovascular disease - the M-PEPS Study. Cerebrovascular Diseases, 2004, 17(4): 314-319.
15. 李凤玲, 时宝林, 刘瑞春. 脑血管病患者血清肺炎衣原体抗体的检测及病因探讨. 脑与神经疾病杂志, 2004, 12(5): 377-378.
16. 邹蓉, 赖颂辉, 刘彦, 等. 脑梗塞患者血清肺炎衣原体特异性抗体的检测. 中国预防医学杂志, 2004, 5(2): 100-102.
17. Johnsen SP, Overvad K, Ostergaard L, et al. Chlamydia pneumoniae seropositivity and risk of ischemic stroke: a nested case-control study. European Journal of Epidemiology, 2005, 20(1): 59-65.
18. 邓英太, 曾莲意, 黄宗青, 等. 缺血性脑卒中与肺炎衣原体感染的关系. 海南医学院学报, 2005, 11(4): 269-271.
19. Njamnshi AK, Blackett KN, Mbuagbaw JN,et al. Chronic chlamydia pneumoniae infection and stroke in Cameroon: a case-control study. Stroke, 2006, 37(3):796-799.
20. Elkind MS, Tondella ML, Feikin DR, et al. Seropositivity to Chlamydia pneumoniae is associated with risk of first ischemic stroke. Stroke, 2006, 37(3): 790-795.
21. 刘爱民, 徐坚, 余竹元. 脑卒中患者血清中的肺炎衣原体抗体和超敏C-反应蛋白. 中国临床康复, 2006, 70(38): 85-86.
22. 曾莲意, 李爱东, 邓英太, 等. 肺炎衣原体感染与急性脑梗死的相关性. 中国误诊学杂志, 2006, 6(7): 1215-1217.
23. 陈蕾, 周玉颖, 马温良, 等. 高敏C反应蛋白和肺炎衣原体感染与颈动脉粥样硬化及缺血性脑卒中的相关性研究. 中华老年心脑血管病杂志, 2006, 8(5): 319-321.
24. 迟兰芹, 王平, 张晨. 肺炎衣原体感染、炎性反应与脑梗死的临床相关性研究. 中国医师进修杂志, 2007, 30(9): 14-16.
25. 李涛, 吴正林, 许香广, 等. 血清肺炎衣原体感染与急性冠脉综合征的关系研究. 中华医院感染学杂志, 2004, 14(5): 499-501.

Chinese Journal of Evidence-Based Medicine

Association between Chlamydia Pneumoniae Infection and Cerebral Infarction: A Meta-analysis

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