Chlamydia Pneumoniae Infection And Cerebrovascular Disease:a Systematic Review And Meta-analysis

Background:Chlamydia pneumoniae(C.pneumoniae) has been linked to cerebrovascular(CV) disease in many studies, but the results were inconsistent. The aim of this meta-analysis was to assess the association between C.pneumoniae infection and CV disease from all available serological and pathological studies.Methods:A comprehensive research was conducted of MEDLINE, EMB ASE, CNKI and WanFang technological periodical database in the internet. We also hand-searched several journals in Chinese to identify eligible case-control and cohort studies. The random effect model was used as pooling method and publication bias was estimated for the results.Results:Fifty-two published studies that met criteria were selected. In case-control studies, an association between CV disease and C.pneumoniae was revealed by serum IgG(OR=1.61;95%CI:1.34～1.94), by serum IgA(OR=2.33;95%CI:1.76-3.08) and by PCR technique of C.pneumoniae in peripheral blood cells(OR=1.90;95%CI:1.17～3.07). No significant association was found in serum IgM or in-situ-detection of arterial biopsies. Subgroup analysis by available studies showed that the association was strongest in patients with stroke of large artery atherosclerosis, but less significant in patients with a stroke due to cardioembilism or other etiologies.Conclusion:Association between C.pneumoniae infection and CV disease depends on the analytical method adopted, which seems higher with stroke due to large artery atherosclerosis. Establishing a causal relationship between C.peumoniae infection and CV disease will require more prospective studies with combination of techniques and stratified by subtypes of CV disease.