罗红霉素治疗肺炎衣原体感染时心血管事件发生影响的研究

目的测定血清肺炎衣原体(TWAR)IgG、IgM抗体滴度水平，采用罗红霉素治疗肺炎衣原体感染，观察冠心病患者的预后心血管事件发生。方法应用间接微量免疫荧光法，测定了115例冠心病病人(CHD组)和60例非冠心病对照者(对照组)入院时的血清TWARIgG、IgM抗体滴度。其中CHD组病人分为不稳定性心绞痛(UAP)组(n=75)和急性心肌梗塞(AMI)组(n=40)。55例UAP病人(TWARIgG≥1∶16)随机分为口服罗红霉素治疗组(150mg/d)和维生素C(Vc)安慰剂组(100mg/d)，治疗7天，于入院28天时复查血清IgG、IgM抗体滴度，同时进行6个月随访，记录心血管事件的发生情况。结果CHD组病人血清TWARIgG平均几何滴度(GMT)(1∶57.77±4.42)与对照组(1∶19.93±4.29)相比有极显著性差异(P＜0.001)。CHD组TWAR既往感染阳性率明显高于对照组(73.91%vs38.33%，P＜0.001)，两组急性感染阳性率无明显差异(P＞0.05)。在随访中，罗红霉素治疗组有3人(10%)发生了心血管事件，而Vc安慰剂组有8人(32%)发生了心血管事件，两组比较有明显差异(P＜0.05)。随着血清TWARIgG抗体滴度升高，其心血管事件的发生率也增高，高水平抗体滴度(1∶256≤IgG≤1∶512)其心血管事件发生率较低水平者(1∶16≤IgG≤1∶64)明显增加(66.67%vs12.50%，P＜0.05)。结论短期的罗红霉素治疗可以降低其心血管事件的发生率。肺炎衣原体感染可能是构成CHD发生发展的一个危险因子。

Effect of Roxithromycin Controlling Chlamydia Pneumoniae Infection on the Incidence of Adverse Cardiovascular Events

Objective To evaluate the association between Roxithromycin curing Chlamydia Pneumoniae infection and coronary heart disease.Methods Using indirect microimmunofluorescence test,we measured levels of Chlamydia Pneumoniae(TWAR) IgG,IgM antibodies in 115 patients with coronary heart disease(CHD) and 60 non-CHD controls.Of the 115 CHD cases,75 cases suffered from unstable angina pectoris(UAP) and 40 acute myocardial infarction(AMI).55 cases with UAP persisting seropositivity of TWAR IgG≥1∶16 were randomly divided into oral Roxithromycin (150 mg/d for 7 days,n=30) and Vitamin C placebo (100 mg/d for 7 days,n=25),and followed up for six months.Results The geometric mean of IgG titer(IgG GMT) and the frequency of chronic infection were significantly higher in patients with CHD than in controls(1∶57.77±4.42 vs 1∶19.93±4.29,P＜0.001;73.91% vs 38.33%,P＜0.001).Of 55 patients followed up for six months,3 cases in oral Roxithromycin and 8 cases in oral Vitamin C placebo were found with adverse cardiovascular events(10% vs 32%,P＜0.05).The incidence of adverse cardiovascular events was increased with TWAR IgG titer increment.Conclusion Taking a short course of Roxithromycin may lower the risk for Chlamydia Pneumoniae.Large antibiotic eradication trials are needed to confirm this founding.Additional laboratory studies are also needed to explore biologic evidences for an association between Chlamydia Pneumoniae and CHD.