干预急性冠脉综合征患者肺炎衣原体感染对其预后的影响

Effect of azithromycin treatment on the prognosis and serum levels of inflammatory mediators in acute coronary syndrome patients

目的探讨阿奇霉素对急性冠脉综合征(ACS)患者肺炎衣原体(chlamydia pneumonia,Cpn)感染、再发冠心病事件及血炎症介质的影响。方法伴Cpn感染的51例不稳定型心绞痛、107例急性心肌梗死患者随机分为对照组(80例)和治疗组(78例),治疗组口服阿奇霉素500mg/d,共3d,而后每周日口服500mg,共4周。结果随访12个月,冠心病事件在治疗组的发生率为14.10%,对照组为30.00%,治疗组相对危险降低53.00%(P=0.0179),其中非致死性急性心肌梗死治疗组为6.75%,对照组为15.85%,治疗组相对危险降低61.37%(P=0.0341);其他事件的发生率治疗组为14.10%,对照组为38.75%,治疗组相对危险降低63.61%(P=0.0050),其中治疗组因心绞痛入院者为7.69%,对照组为20.00%,治疗组相对危险降低61.55%(P=0.0256),PCI/CABG在治疗组为3.85%,对照组为13.75%,治疗组相对危险降低72.00%(P=0.0297)。治疗组血炎症介质水平在治疗后与治疗前及对照组相同时间点比较显著降低(P<0.05或P<0.01)。结论阿奇霉素治疗可降低非致死性急性心肌梗死的发生率、因心绞痛入院率,减少对PCI/CABG的需求,并能降低血炎症介质水平,表明抗感染治疗在冠心病二级预防中起到有益的作用。

Objective To evaluate the effect of azithromycin treatment on chlamydia pneumonia （Cpn） , coronary heart disease and the serum levels of serum inflammatory mediators in acute coronary syndrome patients. Methods 51 unstable angina pectoris patients and 107 acute myocardial infarction patients with Cpn infection were divided into at random control group （ n = 80）and treatment group （ n = 78 ）. Treatment group were treated with azithromycin （ 500 mg/d for 3 days and then 500rag weekly for 4 weeks ） in addition to conventional therapy （ control group）. Results The follow up period was one year. The incidence of the coronary heart disease were 14. 10% in treatment group and 30.00% in control group, with a reduction of relative risk by 53.00% for treatment group （ P = 0.0179 ）. Among them, the incidence of non -fatal myocardial infarction reduced by 61.37% in treatment group, compared with control group （ 6.75 % vs 15.85 %, P = 0.0341 ） ; the incidence of other events also decreased by 63.61% in treatment group compared with control group { 14.10% vs 38.75%, P =0.0050）. Among them, the demand for PCI/CABG was 3.85% in treatment group and 13.75% in control group, with a reduction of relative risk by 72.00% in treatment group （ P =0.0297 ） ,readmission with angina reduced by 61.55% in treatment group compared with control group（7.69% vs 20.00%, P =0.0256）. The serum levels of inflammatory mediators in treatment group were obviously lower than those in control group after treatment （ P 〈 0. 01 ）. Conclusion Azithromycin can significantly decrease the incidence of non - fatal myocardial infarction, readmission with angina, the demand for PCI/CABG and the serum levels of inflammatory mediators, and play a beneficial role in the secondary prevention of coronary heart disease.