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1、·730·ChinJNosocomiolVol.14No.72004·論 著·阿奇霉素對肺炎衣原體感染及冠心病二級預(yù)防的臨床研究李 濤,吳正林,許香廣,張國良,黃建平,胡雪松,李 松,吳劍勝,方衛(wèi)華(深圳市福田人民醫(yī)院,廣東深圳518033)摘要:目的 探討阿奇霉素長期小劑量應(yīng)用對冠心病二級預(yù)防的作用。方法 選擇符合冠心病診斷標(biāo)準(zhǔn)的180例患者,其中無癥狀型冠心病75例,不穩(wěn)定型心絞痛53例,急性心肌梗死52例,采用隨機(jī)雙盲安慰劑對照的方法,按隨機(jī)數(shù)字表分為阿奇霉素治療組及安慰劑對照組,兩組藥物的藥品包裝名均為阿奇霉素。結(jié)果 180例患者中89例納入阿奇霉素組,隨訪1年,13例出現(xiàn)冠心事
2、件,發(fā)生率14.6%,安慰劑組91例27例出現(xiàn)冠心事件,發(fā)生率29.7%,阿奇霉素組冠心事件發(fā)生率低于安慰劑組,減少了15.1%,OR0.405,95%的CI0.193～0.85;阿奇霉素組有4例因出現(xiàn)上腹痛、惡心退出研究,3例出現(xiàn)腹脹、惡心但程度輕,能耐受,副作用發(fā)生率為7.9%,安慰劑組有6例出現(xiàn)腹脹,2例不能耐受,退出研究,副作用發(fā)生率為6.6%,兩組間差異無顯著性;兩組治療前后IgG抗體滴度及各組治療后抗體滴度的差值比較差異無顯著性。結(jié)論 研究結(jié)果表明阿奇霉素能減少冠心病的癥狀發(fā)生,對冠心病二級預(yù)防有一定療效,長期小劑量應(yīng)用安全、耐受性好,但隨訪治療前后及治療后IgG抗體滴度無變
3、化。關(guān)鍵詞:肺炎衣原體;微量免疫熒光抗體;冠心病;阿奇霉素;二級預(yù)防中圖分類號:R978.1文獻(xiàn)標(biāo)識碼:A文章編號:100524529(2004)0720730204Low-doseUsageofAzithromycinforSecondaryPreventioninPatientswithCoronaryHeartDisease:ADoubleBlindRandomizedStudyLITao,WUZheng2lin,XUXiang2guang,ZHANGGuo2liang,HUANGJian2ping,HUXue2song,LISong,WUJian2sheng,FANGWei2hu
4、a(ShenzhenFutianHospital,Shenzhen518033,China)Abstract:OBJECTIVEToobservetheclinicaleffectofusageofazithromycinwithdoubleblindrandomized,low2doseandlongtermmannerandwhetherantibioticshaveaprotectiveroleincoronaryheartdisease.METH2ODSAtotalof180patientswererandomlyallocatedtoreceiveplaceboorazithr
5、omycin.Therewere0.25gdailyforonemonth;0.25gtwiceweeklyfortwomonths;0.25gonceweeklyforthreemonths.Patientswerefol2lowedupatbaseline,weeks1and4whilereceivingtherapyandthenevery3monthsforoneyear.Thecoronaryarteryeventsincludedrecurrentischemianecessitatingrevascularization,cardiovasculardeath,recurr
6、entmyocar2dialinfarction,suddendeath,congestiveheartfailure,resuscitatedcardiacarrestwererecordedandserologyofChlamydiapneumoniae2specificIgGantibodieswasmeasuredbymicroimmunofluorescencetest.RESULTSThecoronaryarteryeventsweredecreasedinazithromycingroupcomparedwithplaceboonefrom29.7%to14.6%.Thea
7、zithromycinwasgenerallywelltolerated.Therateofsideeffectswas7.9%withazithromycinand6.6%withplacebo.Nosignificantdifferencewasfoundbetweentwogroups.GeometricmeanIgGtiterwasnosignifi2cantdifferenceaftertreatmenteitherinp
