冠心病与肺炎衣原体感染的关系及治疗探讨

目的 :测定冠心病患者外周血单核细胞中肺炎衣原体 (Cpn) DNA,对 DNA阳性患者予阿奇霉素治疗 ,探讨肺炎衣原体感染与冠心病的相关性。方法 :应用巢式 PCR(n PCR)法测定 1 5 0例冠心病患者 (冠心病组 )及 5 5例非冠心病患者 (非冠心病组 )外周血单核细胞中肺炎衣原体 DNA,对 Cpn DNA阳性的冠心病组患者采用随机双盲安慰剂对照的方法分成两组 ,分别予阿奇霉素及安慰剂治疗 3个月 ,复查血 Cpn DNA。结果 :冠心病患者肺炎衣原体 DNA阳性 4 9例 ,阳性率 32 .7%,非冠心病组 1例阳性 ,阳性率为 1 .8%,冠心病组与非冠心病组比较阳性率明显增高 (P<0 .0 0 1 ) ,(相对危险度为 2 6 .2 ,95 %的可信区间为 3.5 2～ 1 94 .98) ,冠心病各亚组间阳性率差异无显著性 (P>0 .0 5 ) ,治疗组经阿奇霉素治疗后 DNA转阴率为 86 .9%,对照组为 5 9.1 %,治疗组疗效明显优于对照组 (P<0 .0 1 )。结论 :冠心病患者外周血单核细胞中肺炎衣原体 DNA阳性率高 ,阿奇霉素治疗干预对 Cpn DNA阴转有效。

The clinical study of detection of chlamydia pneumoniae DNA in the circulating mononuclear cell fractions of coronary heart disease and azithromycin treatment

Objective:To study the association between infection with chlamydia pneumoniae (Cpn)and coronary heart disease (CHD).Methods:The peripheral blood mononuclear cell(PBMC) Cpn DNA was examined using nested polymerase chain reaction(nPCR) technique and confirmed by electrophoresis in patients with CHD and 55 patients with clinical CHD but angiography result are normal as case control group(CG).Then we conducted a randomized,double-blind,placebo-controlled study of 3 months of azithromycin and placebo treatment. After treatment of study blood sample were collected for repeated measurement.Results:Chlamydia pneumoniae DNA was detected in 49(32.7%) of 150 persons with CHD and in 1(1.8%) of 55 persons with control group.The positivity rates of nPCR in CHD groups were higher than those in control group.OR 26.2,95%CI3.52-194.98. There were significiant difference in Cpn DNA negative rate after the azithromycin and the placebo treatment.Conclusion:Chlamydia pneumoniae is present in PBMC of a significant proportion of persons with CHD . The detection of Cpn DNA in PBMC with nPCR may be of great value for identifying Cpn carriers and for monitoring antichlamydial therapy.