الفهرس 
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Abstract
Helicobacter Pylori infection is one of the most common infectious diseases worlds wide. Although most people infected with this organism never develop complications, H. Pylori infection in others causes ulcers in the stomach and duodenum. H. Pylori has also been recognized as a risk factor for the development of gastric carcinoma and mucosal associated lymphoid tumor. H. Pylori can cause extra gastric diseases including CAD and stroke. Since H. Pylori infection is usually chronic and could not heal without therapy, and since many patients with coronary heart disease have been proved that, they don’t have any of the traditional risk factors for life threatening CAD, Searching for additional risk factors for CAD is important to increase the chance for prevention and treatment of diseases that result from atherosclerosis as CAD Recently, it has been proposed that the potential role of infection with H.Pylori contributes to the development of atherosclerosis, through chronic inflammatory response to the chronic bacterial infection probably of autoimmune nature, as pathologic changes of the atheromatus plaques show features of chronic inflammation , also through increased concentration of homocysteine in blood caused by decreased level of folic acid and cobalamine as hyper homocysteinaemia cause endothelial dysfunction, oxidation of low density lipoprotein cholesterol and platelet activation . Helicobacter Pylori may also induce lipid per oxidation producing oxidized low density lipoprotein which is an important component of both early development and late evolution of atheromatus lesions. Another potential mechanism is through direct infection of vascular tissue.The results of previous studies have shown an association between infection with H. Pylori and development of CAD.If such an association is proved and patients with an infectious basis of CAD can be identified, a therapy directed at eradication of the offending organism may be appropriate for those patients.The aim of the present study is to detect possible association between H. Pylori infection as measured by serum antibodies and development of CAD in a case-control study.The present study was conducted on 40 patients presented with chest pain, who were referred to the cardiology department in Shebin Elkom university hospital, they were chosen among 60 patients after exclusion of, diabetic patients, patients with rheumatic heart disease hypertensive patients, patients with congenital heart diseases, cigarette smokers, patients with family history of ischemic heart disease and patients were treated for H.Pylori. Patients were compared to controls of apparently 20 healthy individuals matched for age and sex The forty patients were males at ages 30-49 (mean age 44) years old.Our sample was divided into 2 groups:Group I (Patients group): 40 patients presented with chest pain Group II (control group): 20 healthy persons matched for age and sex.In both groups (group I and group II),careful history was taken ,thorough clinical examination was done, then twelve lead surface electrocardiograms (ECG), laboratory investigations including complete blood picture (CBC), serum LDL cholesterol, serum triglycerides, then the titer of antibodies of (Ig G) type against Helicobacter Pylori was done.In the patient group (GroupI) serum level of cardiac enzymes Creatine Kinase (CK), Lactic Dehydrogenase1 (LDH1), and coronary
angiography was also done.Based on the laboratory results group1 was divided into two subgroups according to H. Pylori seropositivity.1- Group I-A (H. Pylori positive): They were 31 (77.5%) out of 40 patients 2-Group I-B (H. Pylori negative): They were 9(22.5%) out of 40 patients The results of the present study showed that H. Pylori IgG seropositivity was higher in patient group (77.5%) than control group (45%) provided that, seropositivity of H. Pylori was not related to any of the coronary risk factors. H. Pylori positive cases more presented with atypical chest pain than H. pylori negative cases (38.7% of H. Pylori positive to 11.1% of H.Pylori negative) cases.Epigastric pain was more among H. Pylori positive than H. Pylori negative cases as 87.1% of H. Pylori positive cases to 22.2 % of H. Pylori negative cases) were presented with epigastric pain, it was a highly significant factor ( P<0.001). Dyspepsia was more among H. Pylori positive than H. Pylori negative cases as(71% of H. Pylori positive cases to 22.2 % of H. Pylori negative cases) were presented with dyspepsia it was a significant factor as (P<o.o5).WBCs count was significantly higher among H. Pylori positive than H. Pylori negative cases, it was a highly significant factor as (Significance < 0.001).Serum LDL cholesterol level was significantly higher among H.Pylori positive than H. Pylori negative case as it was a highly significant factor as (Significance <0.001<Triglyceride level is significantly higher among H. Pylori positivethan negative cases, it was a significant factor as (significance <0.05).Serum LDH1 level was significantly higher among H. Pylori positive than H. Pylori negative case it was a significant factor as(Significance <0.05)Serum CK level was significantly higher among H. Pylori positive than H. Pylori negative case it was a significant factor as (Significance<0.05)The proportion of H. Pylori positive cases with 3 vessel disease was (48.4%) to non of H. pylori negative cases, the proportion of H.Pylori positive cases with 2 vessel disease was (29.9%) to (22.2 %)among H. pylori negative cases, the proportion of H. Pylori positive cases
with one vessel disease was (22.6%) to (77.8)% among H. pylori negative, So the number of the affected vessels is significantly more among H. Pylori positive cases, it was a significant factor as (P<0.05).The number of the affected vessels is directly proportionate to the infection load (mean Ig G level) it was a significant factor as(significance <0.05).The present data confirm an association between H. Pylori infection and development of CAD, it also suggest that the severity of CAD is more among H. Pylori positive than H. Pylori negative cases as the multi vessel disease is more among H. Pylori positive than H. pylori negative, cardiac enzyme level is more among H. Pylori positive cases and WBCs is more among H. Pylori positive cases and also suggest that, the severity of CAD directly proportionate to the severity of H. Pylori infection( infection load) as the titer of IgG antibodies is higher inmultivessel than single vessel disease.