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目的测定血清肺炎衣原体 (TWAR) Ig G、Ig M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 6 0例非冠心病对照者 (对照组 )入院时的血清 TWAR Ig G、Ig M抗体滴度。其中 CHD组病人分为不稳定性心绞痛(U AP)组 (n=75 )和急性心肌梗塞 (AMI)组 (n=40 )。 5 5例 U AP病人 (TWAR Ig G≥ 1∶ 16 )随机分为口服罗红霉素治疗组 (15 0 m g/ d)和维生素 C(Vc)安慰剂组 (10 0 m g/ d) ,治疗 7天 ,于入院 2 8天时复查血清 Ig G、Ig M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 TWAR Ig G平均几何滴度 (GMT)(1∶ 5 7.77± 4.42 )与对照组 (1∶ 19.93± 4.2 9)相比有极显著性差异 (P<0 .0 0 1)。 CHD组 TWAR既往感染阳性率明显高于对照组 (73.91% vs 38.33% ,P<0 .0 0 1) ,两组急性感染阳性率无明显差异 (P>0 .0 5 )。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 .0 5 )。随着血清 TWAR Ig G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∶ 2 5 6≤ Ig G≤1∶ 5 12 )?
Objective To determine the titers of Ig G and Ig M antibodies in serum of Chlamydia pneumoniae (TWAR) patients and treat the patients with Chlamydia pneumoniae infection by roxithromycin and to observe the occurrence of cardiovascular events in patients with coronary heart disease. Methods Serum TWAR Ig G and Ig M antibody titers were measured in 115 CHD patients and 60 non-CHD controls (control group) by indirect immunofluorescence assay. Patients in the CHD group were divided into unstable angina (UAP) group (n = 75) and acute myocardial infarction (AMI) group (n = 40). Fifty-five UAP patients (TWAR Ig G ≥ 1: 16) were randomized to oral roxithromycin (150 mg / d) and vitamin C (Vc) placebo (10 mg / d) At 7 days, the serum Ig G and Ig M antibody titers were rechecked at 28 days and were followed up for 6 months. The incidence of cardiovascular events was recorded. Results The mean serum TWAR IgG titer (GMT) in CHD group (1: 5 7.77 ± 4.42) was significantly different from that in control group (1: 19.93 ± 4.29) (P <0.01) . The positive rate of TWAR infection in CHD group was significantly higher than that in control group (73.91% vs 38.33%, P <0.01). There was no significant difference in the positive rate of TWAR infection between two groups (P> 0.05). During the follow-up, cardiovascular events were observed in 3 (10%) patients in the roxithromycin group and in 8 patients (32%) in the Vc placebo group, with significant differences between the two groups (P < 0 .0 5). As the titer of serum TWAR Ig G increased, the incidence of cardiovascular events also increased. High titers of antibodies (1:256≤IgG≤1: 5 12)?