Gupta S, Leatham E W, Carrington D, Mendall M A, Kaski J C, Camm A J
Department of Cardiological Sciences, St George's Hospital Medical School, London, UK.
Circulation. 1997 Jul 15;96(2):404-7. doi: 10.1161/01.cir.96.2.404.
The clinical significance of the association between elevated anti-Chlamydia pneumoniae (Cp) antibody titres and coronary heart disease (CHD) is unclear. We explored the relationship between antibodies against Cp and future cardiovascular events in male survivors of myocardial infarction (MI). The effect of azithromycin antibiotic therapy was assessed in a subgroup of post-MI patients.
We screened 220 consecutive male survivors of MI for anti-Cp antibodies. Of these, 213 patients were stratified into three groups: group Cp-ve (n=59), no detectable Cp antibodies; group Cp-I (n=74), intermediate titres of 1/8 to 1/32 dilution; and group Cp+ve (n=80), seropositive at > or = 1/64 dilution. Patients with persisting seropositivity of > or = 1/64 were randomized to either oral azithromycin (Cp+ve-A, 500 mg/d for 3 days [n=28] or 500 mg/d for 6 days [n=12]) or placebo (Cp+ve-P, n=20). Cp+ve-NR (n=20) represented patients not recruited into the antibiotic trial. The incidence of adverse cardiovascular events (over a mean follow-up period of 18+/-4 months) was recorded and shown to increase with increasing anti-Cp titre: Cp-ve, n=4 (7%); Cp-I, n=11 (15%); Cp+ve-NR, n=6 (30%); and Cp+ve-P, n=5 (25%). Cp+ve-NR and Cp+ve-P groups had a fourfold-increased risk for adverse cardiovascular events compared with the Cp-ve group (odds ratio [OR], 4.2; 95% confidence interval [CI], 1.2 to 15.5; P=.03). In contrast, the OR for cardiovascular events in patients receiving azithromycin (Cp+ve-A, single or double course) was the same as in the Cp-ve group (OR, 0.9; 95% CI, 0.2 to 4.6, P=NS). Patients receiving azithromycin were more likely to experience a decrease in IgG anti-Cp titres than were those in the placebo group (P=.02).
An increased anti-Cp antibody titre may be a predictor for further adverse cardiovascular events in post-MI patients. Taking a short course of azithromycin may lower this risk, possibly by acting against Cp.
抗肺炎衣原体（Cp）抗体滴度升高与冠心病（CHD）之间关联的临床意义尚不清楚。我们探讨了心肌梗死（MI）男性幸存者中抗Cp抗体与未来心血管事件之间的关系。在心肌梗死后患者的一个亚组中评估了阿奇霉素抗生素治疗的效果。
我们对220例连续的心肌梗死男性幸存者进行了抗Cp抗体筛查。其中，213例患者被分为三组：Cp-ve组（n = 59），未检测到Cp抗体；Cp-I组（n = 74），滴度为1/8至1/32稀释度的中等水平；Cp+ve组（n = 80），血清学阳性，稀释度≥1/64。持续血清学阳性≥1/64的患者被随机分为口服阿奇霉素组（Cp+ve-A组，500mg/d，共3天[n = 28]或500mg/d，共6天[n = 12]）或安慰剂组（Cp+ve-P组，n = 20）。Cp+ve-NR组（n = 20）代表未纳入抗生素试验的患者。记录不良心血管事件的发生率（平均随访期为18±4个月），结果显示其随着抗Cp滴度的升高而增加：Cp-ve组，n = 4（7%）；Cp-I组，n = 11（15%）；Cp+ve-NR组，n = 6（30%）；Cp+ve-P组，n = 5（25%）。与Cp-ve组相比，Cp+ve-NR组和Cp+ve-P组发生不良心血管事件的风险增加了四倍（优势比[OR]，4.2；95%置信区间[CI]，1.2至15.5；P = 0.03）。相比之下，接受阿奇霉素治疗的患者（Cp+ve-A组，单疗程或双疗程）发生心血管事件的OR与Cp-ve组相同（OR，0.9；95%CI，0.2至4.6，P = 无统计学意义）。接受阿奇霉素治疗的患者比安慰剂组患者更有可能出现IgG抗Cp滴度下降（P = 0.02）。
抗Cp抗体滴度升高可能是心肌梗死后患者发生进一步不良心血管事件的预测指标。短期服用阿奇霉素可能会降低这种风险，可能是通过对抗肺炎衣原体来实现的。
