脂質低下療法による動脈硬化症の進展抑制におけるC型肝炎ウイルス及肺炎クラミジア感染の影響

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  • Both Hepatitis C Virus and Chlamyaia Pneumoniae lnfection are Related to the Progression of Carotid Atherosclerosis in Patients Undergoing Lipids Lowering Therapy
  • Both Hepatitis C Virus and Chlamydia Pneumoniae Infection are Related to the Progression of Carotid Atherosclerosis in Patients Undergoing Lipids Lowering Therapy

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Recent experimental and epidemiological findings suggest that infectious agents may play a role in the development and progression of atherosclerosis. We previously reported that Chlamydia Pneumoniae(C.pneumoniae)infection reduces the effectiveness of lipid-lowering therapy for carotid atherosclerosis and that this microorganism may play a role in the progression of atherosclerosis. In this study, we investigated the possible association between hepatitis C virus (HCV)　infection and carotid arteriosclerosis. A total of 165 asymptomatic hypercholesterolemic patients were randomized to receive probucol(500mg/day, n=82) or pravastatin(10　mg/day, n＝83) and were followed for 2 years. The 2-year change of the maximum common carotid artery intima-media thickness (Max-IMT) was the primary endpoint, while the Max-IMT and the incidence of major cardiovascular events were secondary endpoint. All serum samples were tested for antibody to HCV (anti-HCV) by enzyme-linked immunosorbent assay (ELISA), and all anti-HCV-positive samples were assayed for HCV RNA. Patients without HCV infection(n=25) showed a significant reduction of Max-IMT(-10.90%)(p<O.OOO1), while a small decrease of Max-IMT was noted in the patients with HCV infection (n=25)(-0.3%). Significant differences in the reduction of serum total cholesterol and LDL cholesterol were found between patients with and without HCV infection(both p<0.OOO1). No significant difference in therapeutic effect was noted between the probucol and the pravastatin groups. After adjustment for confounding risk factors, both C. peumoniae infection and anti-HCV positivity were associated with a greater risk of an increase in Max-IMT(8.5635[1.3738-15.7532],　p<O.05, 9.5040[O.2886-18.7194], p<O.05, respectively). These findings suggest that both chronic HCV infection and C.pneumoniae infection can reduce the effectiveness of lipid-lowering therapy for carotid atherosclerosis, and that the HCV may play a role in the progression of atherosclerosis in HCV infected patients．

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