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系統識別號 U0026-0812200911252800
論文名稱(中文) 初發急性心肌梗塞之流行病學研究 : 肺炎披衣菌感染之探討
論文名稱(英文) Epidemiologic study of first-episode acute myocardial infarction: Investigation of the role of Chlamydia pneumoniae infection
校院名稱 成功大學
系所名稱(中) 公共衛生研究所
系所名稱(英) Graduate Institute of Public Health
學年度 93
學期 1
出版年 94
研究生(中文) 張雅貞
研究生(英文) Ya-Jen Chang
電子信箱 socialego@yahoo.com.tw
學號 t8691103
學位類別 碩士
語文別 中文
論文頁數 90頁
口試委員 召集委員-林立人
口試委員-林尊湄
指導教授-謝佑祥
中文關鍵字 肺炎披衣菌  初發急性心肌梗塞 
英文關鍵字 first-episode acute myocardial infarction  Chlamydia pneumoniae 
學科別分類
中文摘要 摘要

  在世界上多數已開發國家中,冠狀動脈心臟病為主要的死因之一,其中最主要的疾病,急性心肌梗塞,則為台灣國人重要的死因之一。關於其危險因子的探討則著重在如吸菸、高血壓與糖尿病之有無等傳統危險因子的討論居多;然而,以上各種經研究證實的傳統危險因子並無法完全解釋急性心肌梗塞發生的原因。近年來的研究發現,人體感染肺炎披衣菌所造成的慢性發炎在動脈粥狀硬化過程中扮演重要的角色,而動脈粥狀硬化所形成的血栓,為引起冠狀動脈血管發生狹窄或阻塞的重要因素之一。歐美國家許多動物實驗研究與血清流行病學研究均顯示,肺炎披衣菌感染可能為急性心肌梗塞此一冠狀動脈心臟病的危險因子之一;而台灣屬於世界上肺炎披衣菌感染之高感染區之一,然而進一步回顧亞洲地區與台灣地區研究之相關文獻,則明顯呈現不足的狀態。本研究進行肺炎披衣菌感染與初發急性心肌梗塞流行病學相關性的探討及肺炎披衣菌感染與傳統危險因子於初發急性心肌梗塞發生之交互作用的分析討論。

  本研究利用流行病學上配對病例對照研究法,病例組與對照組採1:2的個案配對方式。病例組來源為自2003年2月17日至2004年2月16日,奇美醫學中心之初發急性心肌梗塞個案共74位;對照組則於病例組收案結束後於奇美醫學中心之健檢中心進行收案,與病例組配對性別與年齡,共132位。肺炎披衣菌的感染則利用微免疫螢光法(IgG抗體效價≧1:16定義為過去感染)與聚合酵素連鎖反應方法(定義為最近或正在感染)進行偵測;而傳統危險因子資料蒐集則進行吸菸、高血壓及糖尿病有無之病歷與問卷調查。

  研究結果顯示病例組的肺炎披衣菌IgG抗體陽性率為82.4%,而對照組為68.9%(p<0.05)。另外,病例組IgG抗體效價GMT值為14.9,對照組為11.3(p=0.31)。利用聚合酵素連鎖反應方法發現沒有任何參與者最近或正在感染肺炎披衣菌。經由1:2配對之多變項統計分析發現,是否曾有肺炎披衣菌的感染與發生初發急性心肌梗塞之間沒有流行病學研究的相關性存在(OR=1.74, 95% CI=0.63-4.79, p=0.29);不過經由進一步的分析肺炎披衣菌抗體不同效價與發生初發急性心肌梗塞的相關性後,發現若參與者其肺炎披衣菌IgG抗體效價為≧1:32時,是為初發急性心肌梗塞病例組的危險性為那些肺炎披衣菌IgG抗體效價≦1:8者的8.92倍(95% CI=1.84-43.17, p<0.05)。而在控制了其他干擾因子之後,肺炎披衣菌IgG抗體陽性分別與傳統危險因子的暴露:有吸菸(OR=4.04, 95% CI=1.17-14.00,p<0.05)、有糖尿病(OR=5.67, 95% CI=1.55-20.74,p<0.05)、有高血壓(OR=3.90, 95% CI=1.07-14.30,p<0.05)於初發急性心肌梗塞具有交互作用的存在,並且當研究個案四項危險因子都存在時,是為初發急性心肌梗塞病例組的危險性為沒有其他四項危險因子者的12.3倍(95% CI=1.29-118.21, p<0.05)。

  本研究之研究結果發現稍高肺炎披衣菌IgG抗體效價與初發急性心肌梗塞有流行病學相關性存在。而在與傳統的危險因子進行交互作用的分析方面,則發現曾感染肺炎披衣菌與其他傳統危險因子吸菸、高血壓及糖尿病之間對於初發急性心肌梗塞分別具有交互作用的存在,因此肺炎披衣菌感染對於初發急性心肌梗塞可為一重要的效果修飾因子。未來對於包含初發急性心肌梗塞在內的冠狀動脈心臟病之防制策略上,除了對於傳統危險因子的著重之外,針對肺炎披衣菌感染的角色也需要更進一步的思考與整合。



英文摘要 Abstract

  Coronary heart disease (CHD) is one of the predominant causes of death and disability in all industrialized countries. Acute myocardial infarction (AMI), a major disease of CHD, is one of the leading causes of death in Taiwan. Among risk factors identified by epidemiological studies, smoking, hypertension, and diabetes mellitus are considered the most important predictors for the risk of AMI at the individual level.

    It was hypothesized that atherosclerosis results from chronic inflammation. Recent studies have also indicated that chronic infection plays an important role in the process of atherosclerosis. A growing number of seroepidemiologic studies, in vitro tissue culture and animal studies conducted in Western countries have indicated that Chlamydia pneumoniae might be the major infectious cause of atherosclerogensis. However, there have been few epidemiologic studies on the link of C. pneumoniae infection and CHD in Taiwan, where the infection is highly prevalent.

  A 1:2 individual-matched case-control study was conducted to investigate the association between C. pneumoniae infection and first-episode AMI and its effect measure modification on the association between traditional risk factors and AMI. Patients who were admitted to Chi-Mei Medical Center and were diagnosed with first-episode AMI during 2003 February 17 to 2004 February 16 were recruited. Individuals who had health examination at Chi-Mei Medical Center and were matched on sex and age of cases were selected as controls. Venous blood samples were collected and DNAs were extracted from peripheral blood mononuclear cells (PMBC) from all subjects. C. pneumoniae specific IgG antibody was measured by microimmunofluorescence test (IgG titers≧1:16 defined as seropositive or presence of past infection). In addition, presence of current C. pneumoniae infection was detected by polymerase chain reaction on extracted PBMC DNAs. Classical risk factors such as smoking, hypertension and diabetes mellitus were obtained from patients’ medical records and the questionnaires.

  Overall, 74 first-episode AMI cases and 132 controls were recruited. Among cases, 82.4% were C. pneumoniae seropositive as compared to 68.9% of controls (p<0.05). The geometric mean C. pneumoniae IgG titer in cases was 14.9 compared to 11.3 in controls (p=0.31). No recent or current C. pneumoniae infections were found among all participants. C. pneumoniae IgG antibody seropositivity was not associated with first-episode AMI (OR=1.74, 95% CI=0.63-4.79, p=0.29) by multivariate logistic regression analysis. But the C. pneumoniae IgG titer was associated with first-episode AMI. When individuals with C. pneumoniae IgG titer ≧1:32, the odds ratio of having first-episode AMI was 8.92 as compared to those with titer ≦1:8 (95% CI=1.84-43.17, p<0.05). After controlling for other confounding factors, interactions were present between C. pneumoniae IgG antibody seropositivity and other classical risk factors such as- smoking (OR=4.04, 95% CI=1.17-14.00,p<0.05), diabetes mellitus (OR=5.67, 95% CI=1.55-20.74,p<0.05) and hypertension (OR=3.90, 95% CI=1.07-14.30,p<0.05) on the presence of first-episode AMI. Noticeably, when the individuals with all four risk factors were 12.3 times more likely to have first-episode AMI than those without(95% CI=1.29-118.21, p<0.05).

  Our data support the hypothesis that elevated C. pneumoniae IgG antibody titer is an independent risk factor for first-episode AMI in this southern Taiwan population. Results also suggest that presence of past C. pneumoniae infection is an important effect measure modifier on the association of the traditional risk factors and first-episode AMI. The prevention strategy on first-episode AMI and even on CHD should emphasize on an integrated prevention program involving C. pneumoniae infection and other classical risk factors should be warranted in the future.



論文目次 目錄
頁碼
中文摘要 -------------------------------------------------------- Ⅰ
英文摘要 -------------------------------------------------------- Ⅲ
目錄 -------------------------------------------------------- Ⅵ
表次 -------------------------------------------------------- Ⅷ
圖次 -------------------------------------------------------- Ⅹ

第一章 研究動機、目的與重要性-------------------------------- 1

第二章 文獻回顧 ----------------------------------------------- 3
第一節 冠狀動脈心臟病流行病學 --------------------------- 3
第二節 冠狀動脈心臟病傳統危險因子探討 -------------------- 4
第三節 急性心肌梗塞定義及診斷標準 ------------------------ 7
第四節 肺炎披衣菌 ---------------------------------------- 7
第五節 肺炎披衣菌流行病學 -------------------------------- 9
第六節 肺炎披衣菌感染偵測方法 ---------------------------- 11
第七節 肺炎披衣菌感染與冠狀動脈心臟病之血清流行病學 ------ 13
相關性研究
第八節 肺炎披衣菌感染與動脈粥狀硬化之間機制的探討 -------- 16
第九節 冠狀動脈心臟病之抗生素療法臨床實驗研究 ------------ 18
第十節 宿主本身遺傳免疫因子與動脈粥狀硬化 ---------------- 20

第三章 研究材料與方法 --------------------------------- 23
第一節 病例組研究樣本選取及檢體採集 ---------------------- 23
第二節 對照組研究樣本選取及檢體採集 ---------------------- 24
第三節 病例組與對照組研究樣本資料收集 -------------------- 25
第四節 病例組與對照組研究樣本檢體處理 -------------------- 26
第五節 肺炎披衣菌偵測方法 -------------------------------- 28
第六節 資料處理與統計分析 -------------------------------- 35

第四章 研究結果 ----------------------------------------- 37
第一節 病例組研究樣本資料 -------------------------------- 37
第二節 對照組研究樣本資料 -------------------------------- 38
第三節 肺炎披衣菌血清學檢驗結果 -------------------------- 39
第四節 肺炎披衣菌DNA檢測結果 --------------------------- 41
第五節 肺炎披衣菌血清陽性與初發急性心肌梗塞之相關性 ------ 41

第五章 討論 --------------------------------------------- 48
研究優點 -------------------------------------------------- 53
研究限制 -------------------------------------------------- 54

第六章 結論與建議 --------------------------------------- 57

參考文獻 ------------------------------------------------ 59
參考文獻 參考文獻

Aldous MS, Grayston JT, Wang SP. Seroepidemiology of Chlamydia pneumoniae TWAR infection in Seattle families, 1996-1979. J Infect Dis 1992; 166:646-649.

Andreotti F, Porto I, Crea F, Maseri A. Inflammatory gene polymorphisms and ischaemic heart disease: review of population association studies. Heart 2002; 87: 107-112.

Blasi F, et al. A possible association of Chlamydia pneumoniae infection and acute myocardial infarction in patients younger than 65 years of age. Chest 1997; 112: 309-312.

Blasi F, Tarsia P, Arosio C, Fagetti L, Allegra L. Epidemiology of Chlamydia pneumoniae. Cli Microbiol Infect 1998; 4: 4S1-6.

Bloemenkamp DG, Mali WP, Visseren FL, Graaf Y. Meta-analysis of sero-epidemiologic studies of the relation between Chlamydia pneumoniae and atherosclerosis: Does study design influence results? Am Heart J 2003; 145: 409-417.

Boekholdt SM, Bijsterveld NR, Moons AHM, Levi M, Büller HR, Peters RJG.

Genetic variations in coagulation and fibrinolytic proteins and their relation with acute myocardial infarction. Circulation 2001; 104: 3063-3068.

Boman J, Gaydos CA. Polymerase chain reaction detection of Chlamydia pneumoniae in circulating white blood cells. J Infect Dis 2000; 181(Suppl 3): S452-454.

Boman J, Soderberg S, Forsberg J, et al. High prevalence of Chlamydia pneumoniae DNA in peripheral blood mononuclear cells in patients with cardiovascular disease and in middle-aged blood donors. J Infect Dis 1998; 178: 274-277.

Campbell LA, Kuo CC, Grayston JT. Chlamydia pneumoniae and cardiovascular disease. Emerging Infect Dis 1998; 4: 571-579.

Cercek B, et al. Effect of short-term treatment with azithromycin on recurrent ischaemic events in patients with acute coronary syndrome in the Azithromycin in Acute Coronary Syndrome (AZACS) trial: a randomized controlled trial.
Lancet 2003; 361: 809-813.

Chien KL, et al. Sex difference in the mortality trends of acute myocardial infarction in Taiwan, 1974 to 1993. J Formos Med Assoc 1998; 97: 309-314.

Chiya Kosaka, Katsuko Hara, Yutaka Komiyama, Hakuo Takahashi. Possible role of chronic infection with Chlamydia pneumoniae in Japanese patients with acute myocardial infarction. Jpn Circ J 2000; 64: 819-824.

Choi TY, Kim DA, Kim SK, Kang JO, Park SS, Jung SR. Prevalence of specific antibodies to Chlamydia pneumoniae in Korea. J Clin Microbiol 1998; 36: 3426-3428.

Corinna H, Kathrin G, Annemarie G, Eberhard S, Thomas H. Comparison of eleven commercial tests for Chlamydia pneumoniae specific immunoglobulin G in asymptomatic healthy individuals. J Clin Microbiol 2002; 40: 1603-09.

Danesh J, Collins R, Peto R. Chronic infections and coronary heart disease﹕is there a link﹖Lancet 1997; 350: 430-436.

Dowell SF, Peeling RW, Boman J, et al. Standardizing Chlamydia pneumoniae assays: recommendations from the Centers for Disease Control and Prevention (USA) and the Laboratory Centre for Disease Control (Canada). Clin Infect Dis 2001; 33: 492-503.

Einarsson S, Sigurdsson HK, Magnusdottir SD, Erlendsdottir H, Briem H, Gudmundsson S. Age specific prevalence of antibodies against Chlamydia pneumoniae in Iceland. Scand J Infect Dis 1994; 26:393-397.

Ellis RW. Infection and coronary heart disease. J. Med. Microbiol 1997; 46: 535-539.

Eng HL, Chen CH, Kuo CC, Wu JS, Wang CH, Lin TM. Association of CD14 promoter gene polymorphism and Chlamydia pneumoniae infection. J Infect D 2003; 188: 90-97.

Epstein SE, Zhou YF, Zhu J. Infection and atherosclerosis-emerging mechanistic paradigms. Circulation 1999; 100: e20-e28.

Gearpe H, Gearpe J. Increasing prevalence of specific antibodies to Chlamydia pneumoniae in Sweden. Lancet 1993; 341: 381.

Grayston JT, Campbell LA, Kuo CC, et al. A new respiratory pathogen: Chlamydia pneumoniae strain TWAR. J Infect Dis 1990; 161: 618-625.

Grayston JT, Kuo CC, Campbell LA, et al. Chlamydia pneumoniae sp. nov. for Chlamydia sp. strain TWAR. Int J Sys Bacteriol 1989; 39: 88-90.

Grayston JT, Kuo CC, Wang SP, Altman J. A new Chlamydia psittaci strain, TWAR, isolated in acute respiratory tract infections. N Engl J Med 1986; 315: 161-168.

Grayston JT, Wang SP. History of Chlamydia pneumoniae (TWAR). In: Allegra L, Blasi F, eds. Chlamydia pneumoniae: the lung and heart. Milan: Springer, 1999: 1-8.

Grayston JT. Antibiotic treatment of atherosclerotic cardiovascular disease. Circulation 2003; 107: 1228-1230.

Greenland P, Knoll MD, Stamler J, Neaton JD, Dyer AR, Garside DB, Wilson PW. Major risk factors as antecedents of fatal and nonfatal coronary heart disease events. JAMA 2003; 290: 891-897.

Gupta S, Leatham EW, Carrington D, et al. Elevated Chlamydia pneumoniae antibodies, cardiovascular events, and azithromycin in male survivors of myocardial infarction. Circulation 1997; 96: 404-407.

Gurfinkel E, Bozovich G , Beck E, et al. Treatment with the antibiotic roxithromycin in patients with acute non-Q-wave coronary syndromes: the final report of the ROXIS Study. Eur Heart J 1999; 20: 121-127.

Heart Disease and Stroke Statistics-2003 Update. Dallas, TX, American Heart Association, 2002.

Hoymans VY, Bosmans JM, Renterghem LV, Mak R, Ursi D, Wuyts F, Vrints CJ, Ieven M. Importance of methodology in determination of Chlamydia pneumoniae seropositivity in healthy subjects and in patients with coronary atherosclerosis. J Clin Microbiol 2003; 41: 4049-53.

Hubacek JA, Pit’ha J, Skodova Z, Stanek V, Poledne R. C(-260)→T polymorphism is the promoter of the CD14 monocyte receptor gene as a risk factor for myocardial infarction. Circulation 1999; 99: 3218-20.

IM Lee, Kathryn MR, Nancy RC, JoAnn EM, Julie EB. Physical activity and coronary heart disease in women. JAMA 2001; 285: 1447-1454.
Jantos CA. Detection of Chlamydia pneumoniae in clinical specimens by PCR-EIA. In: Johanna L’age-Stehr, eds. Chlamydia pneumoniae and chronic diseases.
Berlin, Germany: Springer Press, 2000: 48-51.

Johanna L’age-Stehr (Ed.). Chlamydia pneumoniae and chronic diseases. Springer, 2000.

Kalayoglu MV, Libby P, Byrne GI. Chlamydia pneumoniae as an emerging risk factor in cardiovascular disease. JAMA 2002; 288: 2724-2731.

Kanamoto Y, Ouchi K, Mizui M, Usui T. Prevalence of antibody to Chlamydia pneumoniae TWAR in Japan. J Clin Microbiol 1991; 29: 816-818.

Karasek RA, Theorell T, Schwartz JE, et al. Job characteristics in relation to the prevalence of myocardial infarction in the US Health Examination Survey (HES) and the Health and Nutrition Examination Survey (HANES). Am J Public Health 1988; 78: 910-918.

Karvonen M, Tuomilehto J, Naukkarinen A, Saikku P. The prevalence and regional distribution of antibodies against Chlamydia pneumoniae (strain TWAR) in Finland in 1958. Int J Epidemiol 1992; 21: 391-398.

Kese D, Hren-Vencelj H, Socan M, Beovic B, Cizman M. Prevalence of antibodies to Chlamydia pneumoniae in Slovenia. Eur J Clin Microbiol Infect Dis 1994; 13: 523-525.

Khot UN, Khot MB, Bajzer CT, Sapp SK, Ohman EM, Brener SJ, Ellis SG, Lincoff AM, Topol EJ. Prevalence of conventional risk factors in patients with coronary heart disease. JAMA 2003; 290: 898-904.

Kuo CC, Jackson LA, Campbell LA, Grayston JT. Chlamydia pneumoniae (TWAR). Clin Microbiol Rev 1995; 8: 451-461.

Labarthe D. Epidemiology and prevention of cardiovascular disease. Caithersburg, Maryland: As Aspen Publication, 1998.

Leinonen M, Saikku P. Animal models for Chlamydia pneumoniae infection. In: Johanna L’age-Stehr, eds. Chlamydia pneumoniae and chronic diseases. Berlin, Germany: Springer Press, 2000: 19-24.

Leinonen M, Saikku P. Evidence for infectious agents in cardiovascular disease and atherosclerosis. Lancet Infect Dis 2002; 2: 11-17.

Leinonen M. Pathogenntic mechanisms and epidemiology of Chlamydia pneumoniae. Eur Heart J 1993; 14: 57-61.

Lin TM, Kuo CC, Chen WJ, Lin FJH, Eng HL. Seroprevalence of Chlamydia pneumoniae in Taiwan. J of Infection 2004; 48: 91-95.
Mahmoud E, Elshibly S, Mardh PA. Seroepidemiologic study of Chlamydia pneumoniae and other chlamydial species in a hyperendemic area for trachoma in the Sudan. Am J Trop Med 1994; 31: 489-494.

Mahony JB, Chong S, Coombes BK, Smieja M, Petrich A. Analytical sensitivity, reproducibility of results, and clinical performance of five PCR assays for detecting Chlamydia pneumoniae DNA in peripheral blood mononuclear cells. J Clin Microbiol 2000; 38: 2622-2627.

Manson JE, Colditz GA, Stampfer MJ, Willett WC, Rosner B, Manson RR, et al. A prospective study of obesity and risk of coronary heart disease in women. N Engl J Med. 1990; 322: 882-889.

Marenberg ME, Risch N, Berkman LF, Floderus B, Ulf de Faire. Genetic susceptibility to death from coronary heart disease in a study of twins. N Engl J Med 1994; 330: 1041-1046.

Mazzoli S, et al. Chlamydia pneumoniae antibody response in patients with acute myocardial infarction and their follow-up. Am Heart J 1998; 135: 15-20.

Meier CR. Antibiotics in the prevention and treatment of coronary heart disease. J Infect Dis 2000; 181(Suppl 3): 558-562.

Meier CR. The possible role of infections in acute myocardial infarction. Biomed and Pharmacother 1999; 53: 397-404.

Mendis S, Arseculeratne YM, Withana N, Samitha S. Chlamydia pneumoniae infection and its association with coronary heart disease and cardiovascular risk factors in a sample South Asian population. International J Cardiology 2001; 79: 191-196.

Mihaela T, Michael FL, Eric BR, Walter CW, Meir JS, Frank BH. Exercise type and intensity in relation to coronary heart disease in men. JAMA 2002; 288: 1994-2000.

Moazed TC, Kuo CC, Grayston JT, Campbell LA. Evidence of systemic dissemination of Chlamydia pneumoniae via macrophages in the mouse. J Infect Dis 1998; 177: 1322-1325.

Muhlestein JB, Anderson JL, Carlquist JF, et al. Randomized secondary prevention trail of azithromycin in patients with coronary artery disease: primary clinical results of the ACADEDMIC study. Circulation 2000; 102: 1755-1760.

Murray CJL, Lopez AD. Mortality by cause for eight regions of the world: Global burden of disease study. Lancet 1997; 349: 1269-1276.
Ni AP, Lin GY, Yang L, et al. A seroepidemiologic study of Chlamydia pneumoniae, Chlamydia trachomatis and Chlamydia psittaci in different populations on the mainland of China. Scand J Infect Dis 1996; 28: 553-557.

Nieto FJ. Infections and atherosclerosis: New clues from an old hypothesis? Am J Epidemiol 1998; 148:937-948.

O’Connor CM, Dunne MW, Pfeffer MA, et al. Azithromycin for the secondary prevention of coronary heart disease events. The WIZARD Study: a randomized controlled trial. JAMA 2003; 290: 1459-1051.

Peggy CW, Edith JM, Nico JD, at al. The relation between blood pressure and mortality due to coronary heart disease among men in different parts of the world. N Engl J Med 2000; 342: 1-8.

Pi-Sunyer FX. Medical hazards of obesity. Ann Intern Med 1993; 199: 655-660.

Piyada W, et al. Chlamydia pneumoniae specific antibodies in Thai patients with myocardial infarction. Jpn J Infect Dis 2002; 55: 49-51.

Pooling Project Research Group. Relationship of blood pressure, serum cholesterol, smoking habit, relative weight and ECG abnormalities to incidence of major coronary events: final report of the Pooling Project. J Chronic Dis.1978; 31: 201-306.

Ridker PM, Kundsin RB, Stampfer MJ, Poulin S, Hennekens CH. Prospective study of Chlamydia pneumoniae IgG seropositivity and risks of future myocardial infarction. Circulation 1999; 99: 1161-1164.

Rosenfeld ME, Blessing E, Lin TM, Moazed TC, Campbell LA, Kuo CC. Chlamydia, inflammation, and atherogenesis. J Infect Dis 2000; 181(Suppl 3): 492-497.

Ross R. Atherosclerosis-an inflammatory disease. N Engl J Med 1999; 340:115-126.

Saikku P, et al. Chronic Chlamydia pneumoniae infection as a risk factor for coronary heart disease in the Helsinki Heart Study. Annals of Internal Medicine 1992; 116: 273-278.

Saikku P, et al. Serological evidence of an association of a novel Chlamydia, TWAR, with chronic coronary heart disease and acute myocardial infarction. Lancet 1988; 2: 983-986.

Saikku P. Chlamydia pneumoniae in atherosclerosis. In: Johanna L’age-Stehr, eds. Chlamydia pneumoniae and chronic diseases. Berlin, Germany: Springer Press, 2000: 73-83.

Saikku P. Chlamydia pneumoniae infection as a risk factor in acute myocardial infarction. European Heart Journal 1993; 14: 62-65.

Saikku P. Epidemiologic associations of Chlamydia pneumoniae and atherosclerosis: the initial serologic observation and more. J of infectious disease 2000; 181: S411-413.

Saikku P. The epidemiology and significance of Chlamydia pneumoniae. J Infect Dis 1992; 25(Suppl.1): 27-34.

Sander D, et al. Reduced progression of early carotid atherosclerosis after antibiotic treatment and Chlamydia pneumoniae seropositivity. Circulation 2002; 106: 2428-2433.

Schernthaner G. Cardiovascular mortality and morbidity in type-2 diabetes mellitus. Diabetes Res Clin Pract 1996; 31(Suppl): S3-13.

Shor A, Kuo CC, Patton D. Detection of Chlamydia pneumoniae in coronary arterial fatty streaks and atheromatous plaques. S Afr Med J 1992; 82: 158-161.

Shor A, Phillips JI. Chlamydia pneumoniae and atherosclerosis. JAMA 1999; 282: 2071-2073.

Taylor-Robinson D, Thomas BJ. Chlamydia pneumoniae in arteries: the facts, their interpretation, and future studies. J Clin Pathol 1998; 51: 793-797.

Tong CYW, Sillis M. Detection of Chlamydia pneumoniae and Chlamydia psittaci in sputum samples by PCR. J Clin Pathol 1993; 46: 313-317.

Tsai CT, et al. Relation of Chlamydia pneumoniae infection in Taiwan to angiographically demonstrated coronary artery disease and to the presence of acute myocardial infarction or unstable angina pectoris. Am J Cardiol 2001; 88: 960-963.

Wald NJ, Law MR, Morris JK, Zhou X, Wong Y, Ward ME. Chlamydia pneumoniae infection and mortality from ischaemic heart disease: large prospective study. BMJ 2000; 321: 204-207.

Wang JH, Liu YC, Cheng DL, Yen MY, Chen YS, Chen BC. Seroprevalence of Chlamydia pneumoniae in Taiwan. Scand J Infect Dis 1993; 25: 565-568.

Wang JM, Su S, Gong W, Oppenheim JJ. Chemokines, receptors, and their role in cardiovascular pathology. Int J Clin Lab Res 1998; 28: 83-90.

Wang SP, Grayston JT. Chlamydia pneumoniae (TWAR) microimmunofluorescence antibody studies-1998 update. In: Stephens RS, Byrne BI, Christiansen G, et al., eds. Chlamydial infections. Berkeley, CA: University of California, 1998: 155-158.

Wang SP, Grayston JT. Immumologic relationship between genital TRIC, lymphogranuloma venereum, and related organisms in a new microtiter indirect immunofluorescence test. Am J Ophthalmol 1970; 70: 367-374.

Wang SP, Grayston JT. Population prevalence antibody to Chlamydia pneumoniae, strain TWAR. In: Bowie WR, Caldwell HD, Jones RP, et al., eds. Chlamydial infections. Cambridge, UK: Cambridge University Press, 1990: 402-405.

Wang SP. The microimmunofluorescence test for Chlamydia pneumoniae infection: technique and interpretation. J Infect Dis 2000; 181(Suppl 3): S421-425.

Wu JS, Lin JC, Chang FY. Chlamydia pneumoniae infection in community-acquired pneumonia in Taiwan. J Microbiol Immunol Infect 2000; 33: 34-38.

Yusuf S, Reddy S, Ounpuu S, Anand S. Global burden of cardiovascular disease. PartⅠ: General considerations, the epidemiologic transition, risk factors, and the impact of urbanization. Circulation 2001; 104: 2746-2753.

Zahn R, Schneider S, Frilling B, et al. Antibiotic therapy after acute myocardial infarction: A prospective randomized study. Circulation. 2003; 107: 1253-1259.

李佩娟:肺炎披衣菌感染對內皮細胞凝血功能的影響。國立成功大學醫事技術學系:碩士論文;民國九十二年。

陳建仁:流行病學原理與方法。台北:聯經出版,2001,p293。

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