Poly Clinic, Central Government Health Scheme, Jaipur, Rajasthan, India.
Int J Gen Med. 2012;5:505-9. doi: 10.2147/IJGM.S31625. Epub 2012 Jun 8.
Two mega trials have raised the question as to whether the hypothesis that infection plays a role in atherosclerosis is still relevant. This controlled preliminary trial investigated an extended dose of azithromycin in the treatment of Chlamydia pneumoniae infection causing coronary artery disease (CAD).
Forty patients with documentary evidence of CAD were screened for immunoglobulin G titers against C. pneumoniae and grouped into either the study group (patients with positive titer, n = 32) or control group (patients with negative titer, n = 8). Cases who met inclusion criteria could not have had coronary artery bypass graft surgery or percutaneous coronary intervention in the preceding 6 months. Informed consent was obtained from every patient. Baseline blood samples were analyzed for red blood cell indices, serum creatinine, and liver function tests, and repeated every 2 months. A primary event was defined as the first occurrence of death by any cause, recurrent myocardial infarction, coronary revascularization procedure, or hospitalization for angina. Patients in the study group received 500 mg of oral azithromycin once daily for 5 days, which was then repeated after a gap of 10 days (total of 24 courses in the 1-year trial period). The control group did not have azithromycin added to their standard CAD treatment.
In the study group, 30 patients completed the trial. Two patients had to undergo percutaneous coronary intervention in the initial first quarter of the 1-year trial period. In the control group, one patient died during the trial, one had to undergo coronary artery bypass graft surgery, and one had percutaneous coronary intervention.
The patients tolerated the therapy well and there was a positive correlation between azithromycin and secondary prevention of CAD.
两项大型试验提出了这样一个问题，即感染在动脉粥样硬化中起作用的假设是否仍然相关。本对照初步试验研究了克拉霉素在治疗引起冠心病（CAD）的肺炎衣原体感染中的扩展剂量。
对有文献记录的 CAD 患者进行了针对肺炎衣原体的 IgG 滴度检测，将其分为研究组（滴度阳性，n=32）或对照组（滴度阴性，n=8）。符合纳入标准的病例在过去 6 个月内不能进行冠状动脉旁路移植术或经皮冠状动脉介入治疗。每位患者均获得知情同意。基线时分析了红细胞指数、血清肌酐和肝功能检查，并每 2 个月重复一次。主要事件定义为任何原因导致的死亡、复发性心肌梗死、冠状动脉血运重建术或因心绞痛住院的首次发生。研究组患者每天口服 500mg 阿奇霉素 5 天，然后在 10 天后再次服用（1 年试验期间共服用 24 个疗程）。对照组在标准 CAD 治疗中未添加阿奇霉素。
研究组 30 例患者完成了试验。2 例患者在 1 年试验的最初一季度需要进行经皮冠状动脉介入治疗。对照组中，1 例患者在试验期间死亡，1 例需要进行冠状动脉旁路移植术，1 例需要进行经皮冠状动脉介入治疗。
患者耐受良好，阿奇霉素与 CAD 的二级预防之间存在正相关。
